Healthcare Provider Details

I. General information

NPI: 1659329886
Provider Name (Legal Business Name): CHERYL L LANGO-MADER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7689 SAGAMORE HILLS BLVD
SAGAMORE HILLS OH
44067-2960
US

IV. Provider business mailing address

7689 SAGAMORE HILLS BLVD
SAGAMORE HILLS OH
44067-2960
US

V. Phone/Fax

Practice location:
  • Phone: 330-467-8101
  • Fax: 330-468-3948
Mailing address:
  • Phone: 330-467-8101
  • Fax: 330-468-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number34-008068
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: