Provider Demographics
NPI:1639274285
Name:LANG, CHRISTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:MYGDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8615
Mailing Address - Country:US
Mailing Address - Phone:970-266-3650
Mailing Address - Fax:970-266-3660
Practice Address - Street 1:4674 SNOW MESA DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8615
Practice Address - Country:US
Practice Address - Phone:970-266-3650
Practice Address - Fax:970-266-3660
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39388207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00085989Medicare PIN
CO435518Medicare PIN
COH36345Medicare UPIN