Provider Demographics
NPI:1134522675
Name:MARTIN, LANGMIA SR
Entity type:Individual
Prefix:
First Name:LANGMIA
Middle Name:
Last Name:MARTIN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9867 GOOD LUCK RD APT 11
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3227
Mailing Address - Country:US
Mailing Address - Phone:240-882-0426
Mailing Address - Fax:
Practice Address - Street 1:9867 GOOD LUCK RD APT 11
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3227
Practice Address - Country:US
Practice Address - Phone:240-882-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1005133164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse