Provider Demographics
NPI:1073533626
Name:LANG, PAMELA JUNE (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JUNE
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 1:2428 FOX AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1925
Mailing Address - Country:US
Mailing Address - Phone:608-438-1622
Mailing Address - Fax:
Practice Address - Street 1:2428 FOX AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1925
Practice Address - Country:US
Practice Address - Phone:608-438-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66334207X00000X
WI50-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI50-039OtherATHLETIC TRAINER