MEDICARE: DR. PHILIP LANGSDORF PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	B10000298	DE

General Provider Information

NPI Number	:	1013959634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP LANGSDORF PHD

Provider Business Mailing Address
First Line	:	1400 PEOPLES PLZ
Second Line	:	SUITE 204
City	:	NEWARK
State	:	DE
Zip	:	19702-5707
Country	:	US
Telephone Number	:	302-832-1282
Fax Number	:	302-832-7313

Provider Business Practice Location Address
First Line	:	1400 PEOPLES PLZ
Second Line	:	SUITE 204
City	:	NEWARK
State	:	DE
Zip	:	19702-5707
Country	:	US
Telephone Number	:	302-832-1282
Fax Number	:	302-832-7313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/08/2007

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