Healthcare Provider Details

I. General information

NPI: 1699798769
Provider Name (Legal Business Name): EDWARD M LANG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 JENA ST
NEW ORLEANS LA
70115-6325
US

IV. Provider business mailing address

P O BOX 7764
METAIRIE LA
70010-7764
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-3627
  • Fax: 504-897-3339
Mailing address:
  • Phone: 504-897-3627
  • Fax: 504-897-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPD092R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: