Provider Demographics
NPI:1063403780
Name:LANG, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LANG
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 9135
Mailing Address - Street 2:ATT:SHARON SILVA
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-9135
Mailing Address - Country:US
Mailing Address - Phone:800-927-0002
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42489208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7500162OtherUNITED HEALTHCARE MA
NH30001165OtherMEDICAID NH
MAAA9223OtherHARVARD PILGRIM
MAM09798OtherBCBS MA
MA99277901OtherNETWORK HEALTH
MA2062313Medicaid
RIPL25420Medicaid
MAB20232601OtherCIGNA MA
NY683005Medicaid
MAAA9223OtherHARVARD PILGRIM
MA7500162OtherUNITED HEALTHCARE MA