Provider Demographics
NPI:1871548537
Name:LANGENDERFER, MARY C (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:LANGENDERFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7609
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-7609
Mailing Address - Country:US
Mailing Address - Phone:406-329-7598
Mailing Address - Fax:406-721-3907
Practice Address - Street 1:500 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4008
Practice Address - Country:US
Practice Address - Phone:406-329-7598
Practice Address - Fax:406-721-3907
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0066053Medicaid
M000001634Medicare PIN
MT0066053Medicaid
E32851Medicare UPIN