Healthcare Provider Details

I. General information

NPI: 1003872367
Provider Name (Legal Business Name): NICOLE V LANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 19TH ST NW STE 708
WASHINGTON DC
20036
US

IV. Provider business mailing address

PO BOX 33879
WASHINGTON DC
20033
US

V. Phone/Fax

Practice location:
  • Phone: 202-955-5625
  • Fax: 202-955-5626
Mailing address:
  • Phone: 202-955-5625
  • Fax: 202-955-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD30285
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: