Organization
CHICORA MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERNARD LEROY LANGSTON III MD (PRESIDENT)
(910) 754-8731
Entity
Organization
Contact information
Practice address
341-B WHITEVILLE RD, SHALLOTTE, NC 28470
(910) 754-8731
(910) 754-3153
Mailing address
PO BOX 2528, SHALLOTTE, NC 28459
(910) 754-8731
(910) 754-3153
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890180P
—
NC
Enumeration date
03/17/2006
Last updated
12/07/2007
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