Healthcare Provider Details

I. General information

NPI: 1891562187
Provider Name (Legal Business Name): LINDSEY MARIE LANGLESS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8630A
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

825 FAIRFAX AVE
NORFOLK VA
23507-1912
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-9138
  • Fax:
Mailing address:
  • Phone: 757-446-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010266
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: