Healthcare Provider Details

I. General information

NPI: 1992702617
Provider Name (Legal Business Name): MARY CHOISSER LANGFORD ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12011 LEE JACKSON HWY
FAIRFAX VA
22033-3310
US

IV. Provider business mailing address

2101 E JEFFERSON ST 4E
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-383-5495
  • Fax: 703-383-5489
Mailing address:
  • Phone: 301-816-7405
  • Fax: 301-388-1740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024132613
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: