Basic Information
| Provider Information | |||||||||
| NPI: | 1770900714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | MARJORIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | L.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 015 PARKS HALL | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405934609 | ||||||||
| FaxNumber: | 7405934166 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 HOSPITAL DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405664880 | ||||||||
| FaxNumber: | 7405664881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2014 | ||||||||
| LastUpdateDate: | 03/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | LD.4103 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.