Provider Demographics
NPI:1437119732
Name:LANGE, LORLYNE G (DO-RPH)
Entity Type:Individual
Prefix:
First Name:LORLYNE
Middle Name:G
Last Name:LANGE
Suffix:
Gender:F
Credentials:DO-RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6515
Mailing Address - Country:US
Mailing Address - Phone:717-376-6586
Mailing Address - Fax:610-562-6333
Practice Address - Street 1:3560 OLD ROUTE 22
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-8373
Practice Address - Country:US
Practice Address - Phone:717-376-6586
Practice Address - Fax:610-562-6333
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABL5564340207Q00000X
PARP035376L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017174120002Medicaid
PA01061201OtherCAPITAL BLUE CROSS
PA01061201OtherCAPITAL BLUE CROSS
PA0017174120002Medicaid