Provider Demographics
NPI:1003872367
Name:LANG, NICOLE V (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:V
Last Name:LANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33879
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20033
Mailing Address - Country:US
Mailing Address - Phone:202-955-5625
Mailing Address - Fax:202-955-5626
Practice Address - Street 1:1145 19TH ST NW
Practice Address - Street 2:STE 708
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036
Practice Address - Country:US
Practice Address - Phone:202-955-5625
Practice Address - Fax:202-955-5626
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30285208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G86125Medicare UPIN