Provider Demographics
NPI:1649221292
Name:ROBERT LANG, MD PC
Entity Type:Organization
Organization Name:ROBERT LANG, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDBLOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-318-5264
Mailing Address - Street 1:11 WOODLAND RD
Mailing Address - Street 2:2 ND FLOOR
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2342
Mailing Address - Country:US
Mailing Address - Phone:203-318-5264
Mailing Address - Fax:203-318-5203
Practice Address - Street 1:11 WOODLAND RD
Practice Address - Street 2:2 ND FLOOR
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2342
Practice Address - Country:US
Practice Address - Phone:203-318-5264
Practice Address - Fax:203-318-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1177997Medicaid
CTB38177Medicare UPIN
CT1177997Medicaid