Provider Demographics
NPI:1669840344
Name:LANG, BRADLEY CARL (LDN)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:CARL
Last Name:LANG
Suffix:
Gender:M
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:CHILDREN'S HOSPITAL
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:984-974-7908
Mailing Address - Fax:984-974-3217
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:CHILDREN'S HOSPITAL
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:984-974-7908
Practice Address - Fax:984-974-3217
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004570N133V00000X
NCL004570133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric