Basic Information
| Provider Information | |||||||||
| NPI: | 1730307463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777162 | ||||||||
| FaxNumber: | 8437777102 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 N SUMTER ST | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291504972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038835171 | ||||||||
| FaxNumber: | 8033051814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 1164 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 011640 | 05 | SC | MEDICAID | P01232420 | 01 | SC | RAILROAD MEDICARE | OTHER | 0655422 | 01 | SC | CIGNA | OTHER | 30150986 | 01 | SC | SELECT HEALTH | OTHER | 266003 | 01 | SC | MEDCOST | OTHER | AA30048552 | 01 | SC | MEDICARE PTAN | OTHER | 929530 | 01 | SC | WELLCARE | OTHER |