Healthcare Provider Details

I. General information

NPI: 1083886220
Provider Name (Legal Business Name): PATRICIA A LANGILL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CHESTNUT ST
NEEDHAM MA
02492-2578
US

IV. Provider business mailing address

87 CHESTNUT ST P.O. BOX 920369
NEEDHAM MA
02492-2578
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-5515
  • Fax: 781-444-1866
Mailing address:
  • Phone: 781-444-5515
  • Fax: 781-444-1866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number103796
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: