MEDICARE: TONY LANGSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	8972311612	IN

General Provider Information

NPI Number	:	1396370466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY LANGSTON

Provider Business Mailing Address
First Line	:	3618 DAWNWOOD DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-7971
Country	:	US
Telephone Number	:	317-767-9912
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 DAWNWOOD DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-7971
Country	:	US
Telephone Number	:	317-767-9912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	03/09/2020

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Directions to “ TONY LANGSTON ” Practice Location

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