Provider Demographics
NPI:1760369458
Name:LANGDON, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:LANGDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13556 CANADA GOOSE CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-0914
Mailing Address - Country:US
Mailing Address - Phone:571-626-9520
Mailing Address - Fax:
Practice Address - Street 1:13556 CANADA GOOSE CT
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124-0914
Practice Address - Country:US
Practice Address - Phone:571-626-9520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program