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NPI Code Detail

MEDICARE: MS. MARTHA JANE LANG B.A.

MEDICARE: MS. MARTHA JANE LANG B.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1326252263
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARTHA JANE LANG B.A.
Provider Business Mailing Address
First Line : 217 S MADRIVER ST
Second Line :
City : BELLEFONTAINE
State : OH
Zip : 43311-1935
Country : US
Telephone Number : 937-593-9767
Fax Number :
Provider Business Practice Location Address
First Line : 1600 S MAIN ST
Second Line :
City : BELLEFONTAINE
State : OH
Zip : 43311-1508
Country : US
Telephone Number : 937-599-2766
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 07/08/2007

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