Healthcare Provider Details

I. General information

NPI: 1588334775
Provider Name (Legal Business Name): MARLEE MATLOCK LANGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 MEDICAL PARK DR
HICKORY NC
28602-8809
US

IV. Provider business mailing address

2165 MEDICAL PARK DR
HICKORY NC
28602-8809
US

V. Phone/Fax

Practice location:
  • Phone: 828-324-2800
  • Fax: 828-294-9160
Mailing address:
  • Phone: 828-324-2800
  • Fax: 828-330-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10170
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: