Basic Information
Provider Information
NPI: 1528202074
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LANGFITT
FirstName: MAXWELL
MiddleName: KENNETH
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 602658
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282602658
CountryCode: US
TelephoneNumber: 3367162011
FaxNumber:  
Practice Location
Address1: MEDICAL CENTER BLVD
Address2:  
City: WINSTON SALEM
State: NC
PostalCode: 271570001
CountryCode: US
TelephoneNumber: 3367168093
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/28/2009
LastUpdateDate: 08/28/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XS0114X2015-01735NCY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery

No ID Information.


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