Provider Demographics
NPI:1205808169
Name:LANGE, ERWIN (MD)
Entity type:Individual
Prefix:
First Name:ERWIN
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:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-0678
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:603-527-7164
Practice Address - Street 1:80 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3235
Practice Address - Country:US
Practice Address - Phone:603-524-3211
Practice Address - Fax:603-527-7164
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7088207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00089664OtherRAILROAD MEDICARE
NH0107160Y0NH02OtherBCBS OF NH
NH30202076Medicaid
NH0107160Y0NH04OtherANTHEM
NH0107160Y0NH02OtherBCBS OF NH
P00089664OtherRAILROAD MEDICARE
NH0107160Y0NH04OtherANTHEM
NHRE115102Medicare PIN