Provider Demographics
NPI:1952398208
Name:LANG, LINDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:LANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3459 SAINT JOHNS LN
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4015
Mailing Address - Country:US
Mailing Address - Phone:410-465-5454
Mailing Address - Fax:410-465-0022
Practice Address - Street 1:3459 SAINT JOHNS LN
Practice Address - Street 2:SUITE 9
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4015
Practice Address - Country:US
Practice Address - Phone:410-465-5454
Practice Address - Fax:410-465-0022
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG56411Medicare UPIN
MD798L924DMedicare ID - Type Unspecified