Provider Information for 1053822247
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JENNIFER LANGSTON
Sex: Female
NPI: 1053822247
Last Updated: 2017-10-16
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1053822247 | ||||||||
| Enumeration Date | 2017-10-16 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 14 S BROADWAY BALTIMORE, MD 21231-1712 United States Phone: 410-276-1773 | Fax: | ||||||||
| Primary Practice Address | 14 S BROADWAY BALTIMORE, MD 21231-1712 United States Phone: 410-276-1773 | Fax: | ||||||||
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