Provider Demographics
NPI:1487794491
Name:LANG, JOHN ALBERT III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALBERT
Last Name:LANG
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-782-1806
Mailing Address - Fax:919-782-1669
Practice Address - Street 1:3521 HAWORTH DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7216
Practice Address - Country:US
Practice Address - Phone:919-782-1806
Practice Address - Fax:919-782-4756
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
88380OtherMEDCOST
8817678OtherCIGNA
NC8950841Medicaid
110192434OtherRAILROAD MEDICARE
0455272OtherUNITED HEALTHCARE
NC50841OtherBCBS
110192434OtherRAILROAD MEDICARE
88380OtherMEDCOST
D26850Medicare UPIN