MEDICARE: KENNETH RALPH LANGILLE M.D.

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	MD055344L	PA

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	:	1851398531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH RALPH LANGILLE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 836
Second Line	:
City	:	KANE
State	:	PA
Zip	:	16735-0836
Country	:	US
Telephone Number	:	814-837-8950
Fax Number	:	814-837-8232

Provider Business Practice Location Address
First Line	:	628B N FRALEY ST
Second Line	:
City	:	KANE
State	:	PA
Zip	:	16735-9040
Country	:	US
Telephone Number	:	814-837-8950
Fax Number	:	814-837-8232

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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