Healthcare Provider Details

I. General information

NPI: 1316384530
Provider Name (Legal Business Name): THOMAS JOHN LANGAN IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS JOHN LANGAN JR.

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 MAIN ST
OLEAN NY
14760-1532
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326-1394
US

V. Phone/Fax

Practice location:
  • Phone: 716-375-7035
  • Fax: 716-375-7037
Mailing address:
  • Phone: 607-547-3474
  • Fax: 607-547-6553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number291474
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: