MEDICARE: NIKKI LANG M.D,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	MD022559E	PA

General Provider Information

NPI Number	:	1588633804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI LANG M.D,

Provider Business Mailing Address
First Line	:	634 PINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4109
Country	:	US
Telephone Number	:	215-627-1300
Fax Number	:	215-925-2126

Provider Business Practice Location Address
First Line	:	634 PINE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4109
Country	:	US
Telephone Number	:	215-627-1300
Fax Number	:	215-925-2126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/08/2007

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