Provider Demographics
NPI:1114995354
Name:LANG, THOMAS M (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
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 1:509 MEDTECH PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-952-2122
Mailing Address - Fax:423-952-2145
Practice Address - Street 1:100 15TH ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273
Practice Address - Country:US
Practice Address - Phone:276-439-1840
Practice Address - Fax:276-439-1845
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-094065207P00000X
OH35.099885207P00000X
WAMD00021559207P00000X
VA0101250560207R00000X
TN47911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1487892378OtherBCBS
WA8188732Medicaid
IL036094065-7Medicaid
IL036094065-8Medicaid
930115946OtherRAILROAD MEDICARE
WA8867344Medicare PIN
930115946OtherRAILROAD MEDICARE
IL036094065-8Medicaid
IL036094065-7Medicaid
WAA07055Medicare UPIN
MO1114995354Medicaid
MO147480034Medicare PIN
IL1487892378OtherBCBS
WA8188732Medicaid