Basic Information
| Provider Information | |||||||||
| NPI: | 1114348034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | HENRY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5530 WISCONSIN AVE | ||||||||
| Address2: | STE 1620 | ||||||||
| City: | CHEVY CHASE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208154322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017189800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5530 WISCONSIN AVE | ||||||||
| Address2: | SUITE 1620 | ||||||||
| City: | CHEVY CHASE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208154404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017189800 | ||||||||
| FaxNumber: | 3019861672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2013 | ||||||||
| LastUpdateDate: | 10/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0001237305 | VA | N | Nursing Service Providers | Registered Nurse | 367500000X | R187500 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.