MEDICARE: MRS. RITA MARIE LANGWORTH-BREWER PA-C

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	363AS0400X	Surgical Physician Assistant	004184	NY
2	363AS0400X	Surgical Physician Assistant	001002896	NC
3	363AM0700X	Medical Physician Assistant	0010-02896	NC

General Provider Information

NPI Number	:	1437186152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RITA MARIE LANGWORTH-BREWER PA-C

Provider Business Mailing Address
First Line	:	3729 WILLOW STONE LN
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3433
Country	:	US
Telephone Number	:	845-234-2630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 SUNDAY DR STE 309
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-5254
Country	:	US
Telephone Number	:	919-354-7077
Fax Number	:	919-354-7075

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	10/04/2023

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