Provider Demographics
NPI:1336379932
Name:LANGENBERG, KATHERINE ROSSER (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSSER
Last Name:LANGENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:BYRDSTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38549-6031
Mailing Address - Country:US
Mailing Address - Phone:931-864-3187
Mailing Address - Fax:
Practice Address - Street 1:8401 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:BYRDSTOWN
Practice Address - State:TN
Practice Address - Zip Code:38549-6031
Practice Address - Country:US
Practice Address - Phone:931-864-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34219208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics