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General NPI Number Information
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NPI Number | 1760177109
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Entity Type | Individual
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Provider Name | JAYCE M LANG PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 63 THOMAS JOHNSON DR STE E
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City | FREDERICK
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State | MD
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Zip | 21702-4399
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Country | US
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Telephone | 301-687-7053
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Fax |
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Provider Business Mailing Address
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Address Line | 63 THOMAS JOHNSON DR STE E
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City | FREDERICK
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State | MD
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Zip | 21702-4399
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Country | US
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Telephone | 301-694-7600
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C0009483
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License Number State | MD
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