MEDICARE: BERNARD LEROY LANGSTON III MD

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	207Q00000X	Family Medicine Physician	27938	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821066358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARD LEROY LANGSTON III MD

Provider Business Mailing Address
First Line	:	2930 HOLDEN BEACH RD SW
Second Line	:
City	:	SUPPLY
State	:	NC
Zip	:	28462-5702
Country	:	US
Telephone Number	:	910-842-5991
Fax Number	:	910-842-5994

Provider Business Practice Location Address
First Line	:	2930 HOLDEN BEACH RD SW
Second Line	:
City	:	SUPPLY
State	:	NC
Zip	:	28462-5702
Country	:	US
Telephone Number	:	910-842-5991
Fax Number	:	910-842-5994

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	05/03/2017

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