Healthcare Provider Details

I. General information

NPI: 1255440012
Provider Name (Legal Business Name): CHARLOTTA Z LANGLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 26TH AVE E
BRADENTON FL
34208-7707
US

IV. Provider business mailing address

700 8TH AVE W STE 101
PALMETTO FL
34221-4737
US

V. Phone/Fax

Practice location:
  • Phone: 941-708-8600
  • Fax: 941-708-7645
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-845-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME88696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: