Healthcare Provider Details

I. General information

NPI: 1720282148
Provider Name (Legal Business Name): CATHLEEN ANN LANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N VANCOUVER AVE SUITE 201
PORTLAND OR
97227-1630
US

IV. Provider business mailing address

2800 N VANCOUVER AVE SUITE 201
PORTLAND OR
97227-1630
US

V. Phone/Fax

Practice location:
  • Phone: 503-276-9000
  • Fax:
Mailing address:
  • Phone: 503-276-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberMD161797
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: