Provider Demographics
NPI:1497763023
Name:LANG, JEFFREY KEITH (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KEITH
Last Name:LANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 COCHRAN RD
Mailing Address - Street 2:MANOR OAK I, SUITE 600
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1107
Mailing Address - Country:US
Mailing Address - Phone:412-563-8800
Mailing Address - Fax:412-563-8319
Practice Address - Street 1:1910 COCHRAN RD
Practice Address - Street 2:MANOR OAK I, SUITE 600
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-1107
Practice Address - Country:US
Practice Address - Phone:412-563-8800
Practice Address - Fax:412-563-8319
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002130L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA67120OtherMEDPLUS/UNISON
PA1000284OtherGATEWAY
PA128451OtherHIGHMARK
PA77972OtherAETNA
PA00749860Medicaid
PA128451OtherHIGHMARK
PA77972OtherAETNA