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General NPI Number Information
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NPI Number | 1043295892
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Entity Type | Individual
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Provider Name | JESSICA L. FALVO LANG M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 6724 WALES AVE NW SUITE A
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City | MASSILLON
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State | OH
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Zip | 44646-9006
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Country | US
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Telephone | 330-837-4264
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Fax | 330-837-9195
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Provider Business Mailing Address
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Address Line | 6724 WALES AVE NW SUITE A
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City | MASSILLON
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State | OH
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Zip | 44646-9006
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Country | US
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Telephone | 330-837-4264
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Fax | 330-837-9195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35076160F
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License Number State | OH
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