Provider Demographics
NPI:1235136821
Name:LANGO, THERESE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:MARIE
Last Name:LANGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1751 VETERANS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-4930
Mailing Address - Country:US
Mailing Address - Phone:256-766-2118
Mailing Address - Fax:256-766-2101
Practice Address - Street 1:1751 VETERANS DR STE 200
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4930
Practice Address - Country:US
Practice Address - Phone:256-766-2118
Practice Address - Fax:256-766-2101
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23786207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009944310Medicaid
ALF41375Medicare UPIN