Provider Demographics
NPI:1811395205
Name:LANGE, W. ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:W. ROBERT
Middle Name:
Last Name:LANGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 GANGPLANK RD UNIT 110
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-2499
Mailing Address - Country:US
Mailing Address - Phone:410-371-9071
Mailing Address - Fax:
Practice Address - Street 1:835 GANGPLANK RD UNIT 110
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-2499
Practice Address - Country:US
Practice Address - Phone:410-371-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057207207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease