MEDICARE: DR. MARK A LANG M.D.

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
1	207Q00000X	Family Medicine Physician	35072067L	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972508232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A LANG M.D.

Provider Business Mailing Address
First Line	:	303 E ROYALTON RD
Second Line	:	SUITE 204
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-2591
Country	:	US
Telephone Number	:	440-545-2272
Fax Number	:	440-545-5645

Provider Business Practice Location Address
First Line	:	303 E ROYALTON RD
Second Line	:	SUITE 204
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-2591
Country	:	US
Telephone Number	:	440-545-2272
Fax Number	:	440-545-5645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/05/2013

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Directions to “ DR. MARK A LANG M.D.” Practice Location

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