Provider Demographics
NPI:1972508232
Name:LANG, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:303 E ROYALTON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2591
Mailing Address - Country:US
Mailing Address - Phone:440-545-2272
Mailing Address - Fax:440-545-5645
Practice Address - Street 1:303 E ROYALTON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2591
Practice Address - Country:US
Practice Address - Phone:440-545-2272
Practice Address - Fax:440-545-5645
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2013-07-05
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Provider Licenses
StateLicense IDTaxonomies
OH35072067L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2010684Medicaid
OHLA0818164Medicare ID - Type Unspecified
OHG44541Medicare UPIN