Healthcare Provider Details

I. General information

NPI: 1427089374
Provider Name (Legal Business Name): JOCELYN M LANGEVIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MAIN ST STE 9
NORWAY ME
04268
US

IV. Provider business mailing address

193 MAIN ST STE 9
NORWAY ME
04268-5647
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-8766
  • Fax: 207-743-1579
Mailing address:
  • Phone: 207-743-8766
  • Fax: 207-743-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO2777
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02002721A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: