Healthcare Provider Details

I. General information

NPI: 1043323058
Provider Name (Legal Business Name): DAVID KC LANGILLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N LYNNHAVEN RD SUITE100
VIRGINIA BEACH VA
23452-7523
US

IV. Provider business mailing address

615 ELSINORE PL STE 200
CINCINNATI OH
45202-1457
US

V. Phone/Fax

Practice location:
  • Phone: 757-264-9957
  • Fax: 757-963-0444
Mailing address:
  • Phone: 513-834-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0101043050
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number0101043050
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: