Provider Demographics
NPI:1881985802
Name:LANGE, CHARLES ELLIOTT (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ELLIOTT
Last Name:LANGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2700 NW STEWART PKWY
Mailing Address - Street 2:DEPT OF EMERGENCY MEDICINE, MERCY MEDICAL CENTER
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471
Mailing Address - Country:US
Mailing Address - Phone:541-677-4333
Mailing Address - Fax:
Practice Address - Street 1:2700 NW STEWART PKWY
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE, MERCY MEDICAL CENTER
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-677-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR167526207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine