Provider Demographics
NPI:1588633804
Name:LANG, NIKKI (MD,)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
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 1:634 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4109
Mailing Address - Country:US
Mailing Address - Phone:215-627-1300
Mailing Address - Fax:215-925-2126
Practice Address - Street 1:634 PINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4109
Practice Address - Country:US
Practice Address - Phone:215-627-1300
Practice Address - Fax:215-925-2126
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022559E207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108322Medicare ID - Type Unspecified
PAC30331Medicare UPIN