Basic Information
| Provider Information | |||||||||
| NPI: | 1376570515 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANGLEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2989 | ||||||||
| Address2: | |||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437062255 | ||||||||
| FaxNumber: | 8437062257 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 PLANTATION PARK DRIVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437062255 | ||||||||
| FaxNumber: | 8437062257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 12/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/19/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 0101038939 | VA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | CF8401 | 01 | VA | RAILROAD MEDICARE | OTHER | 7531699 | 05 | VA | MEDICAID |