Provider Demographics
NPI:1598070781
Name:LANGE, JOSEPH GILMORE (LMT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GILMORE
Last Name:LANGE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 W MARKET ST
Mailing Address - Street 2:STE A
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44884
Mailing Address - Country:US
Mailing Address - Phone:419-443-8877
Mailing Address - Fax:419-443-8885
Practice Address - Street 1:716 W MARKET ST
Practice Address - Street 2:STE A
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883
Practice Address - Country:US
Practice Address - Phone:419-443-8877
Practice Address - Fax:419-443-8885
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6495174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist