Provider Demographics
NPI:1689851024
Name:STEPHAN C LANGE PC
Entity Type:Organization
Organization Name:STEPHAN C LANGE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-522-7121
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 3208
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-522-7121
Mailing Address - Fax:860-524-0815
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 3208
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-522-7121
Practice Address - Fax:860-524-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025612207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03884Medicare PIN