Provider Demographics
NPI:1427089374
Name:LANGEVIN, JOCELYN M (DO)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:M
Last Name:LANGEVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 MAIN ST STE 9
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5647
Mailing Address - Country:US
Mailing Address - Phone:207-743-8766
Mailing Address - Fax:207-743-1579
Practice Address - Street 1:193 MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268
Practice Address - Country:US
Practice Address - Phone:207-743-8766
Practice Address - Fax:207-743-1579
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO2777208000000X
IN02002721A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000659549OtherANTHEM
ME1427089374Medicaid
IN000000370480OtherANTHEM
IN200519610Medicaid