Provider Demographics
NPI:1699798769
Name:LANG, EDWARD M (DPM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:LANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 7764
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70010-7764
Mailing Address - Country:US
Mailing Address - Phone:504-897-3627
Mailing Address - Fax:504-897-3339
Practice Address - Street 1:2626 JENA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6325
Practice Address - Country:US
Practice Address - Phone:504-897-3627
Practice Address - Fax:504-897-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD092R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1388351Medicaid
213ES0131XOtherTAXONOMY
LA1699798769Medicare PIN
LA56373Medicare ID - Type Unspecified
LAT86556Medicare UPIN