Provider Demographics
NPI:1760177109
Name:LANG, JAYCE M (PA-C)
Entity type:Individual
Prefix:
First Name:JAYCE
Middle Name:M
Last Name:LANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 THOMAS JOHNSON DR STE E
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4399
Mailing Address - Country:US
Mailing Address - Phone:301-694-7600
Mailing Address - Fax:
Practice Address - Street 1:63 THOMAS JOHNSON DR STE E
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4399
Practice Address - Country:US
Practice Address - Phone:301-687-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0009483363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical