Provider Demographics
NPI:1639228679
Name:LANG, DONNA MARIA CREOLA (MPAS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIA CREOLA
Last Name:LANG
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:MARIE CREOLA
Other - Last Name:BEATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:1918 RANDOLPH RD.
Mailing Address - Street 2:STE. 550
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207
Mailing Address - Country:US
Mailing Address - Phone:704-375-6766
Mailing Address - Fax:704-332-6552
Practice Address - Street 1:1918 RANDOLPH RD.
Practice Address - Street 2:STE. 550
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207
Practice Address - Country:US
Practice Address - Phone:704-375-6766
Practice Address - Fax:704-332-6552
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2564363AM0700X
363AM0700X
NC0010-01213363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical