Basic Information
Provider Information
NPI: 1790148120
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LANGFITT
FirstName: TERRY
MiddleName:  
NamePrefix: DR.
NameSuffix: JR.
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 SAM PERRY BLVD
Address2:  
City: FREDERICKSBURG
State: VA
PostalCode: 224014453
CountryCode: US
TelephoneNumber: 5407417614
FaxNumber: 5407417615
Practice Location
Address1: 1001 SAM PERRY BLVD
Address2:  
City: FREDERICKSBURG
State: VA
PostalCode: 224014453
CountryCode: US
TelephoneNumber: 5407417614
FaxNumber: 5407417615
Other Information
ProviderEnumerationDate: 04/02/2016
LastUpdateDate: 08/19/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/19/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X0101268176VAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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