Provider Demographics
NPI:1679512255
Name:LANGER, PHILLIP R (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:R
Last Name:LANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5788 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4904
Mailing Address - Country:US
Mailing Address - Phone:404-935-9110
Mailing Address - Fax:770-234-6803
Practice Address - Street 1:5788 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4904
Practice Address - Country:US
Practice Address - Phone:404-935-9110
Practice Address - Fax:770-234-6803
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98169207X00000X
GA061280207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I55742Medicare UPIN