Provider Demographics
NPI:1740381839
Name:LANGNER, PETRA (MD)
Entity type:Individual
Prefix:DR
First Name:PETRA
Middle Name:
Last Name:LANGNER
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 1:177 OLD NISKAYUNA RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4916
Mailing Address - Country:US
Mailing Address - Phone:518-626-5339
Mailing Address - Fax:
Practice Address - Street 1:177 OLD NISKAYUNA RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4916
Practice Address - Country:US
Practice Address - Phone:518-626-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193627284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital