1750375424 NPI number — ERIC A LANG MD

Table of content: ERIC A LANG MD (NPI 1750375424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750375424 NPI number — ERIC A LANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANG
Provider First Name:
ERIC
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750375424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20452
Provider Second Line Business Mailing Address:
COPA-CRED
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43220-0452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-442-2406
Provider Business Mailing Address Fax Number:
614-442-2410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
793 W STATE ST
Provider Second Line Business Practice Location Address:
MCHS WEST-PATHOLOGY DEPT-COPA
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43222-1551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-234-1300
Provider Business Practice Location Address Fax Number:
614-234-2931
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  35070130 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZC0500X , with the licence number: 35070130 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0790046 . This is a "MCR PTAN-DPA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0790042 . This is a "MCR PTAN-COPA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2237805 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com