1538312194 NPI number — DR. DARLYNE CANGE, DPM, LLC

Table of content: (NPI 1538312194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538312194 NPI number — DR. DARLYNE CANGE, DPM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. DARLYNE CANGE, DPM, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538312194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21041-1606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-733-4770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4367 HOLLINS FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 4A
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-733-4770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CANGE
Authorized Official First Name:
DARLYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
DPM/PODIATRIC PHYSICIAN & SURGEON
Authorized Official Telephone Number:
410-733-4770

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  01457 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 018750060 . This is a "MARYLAND PHYSICIAN CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: D364 . This is a "GHMSI- BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 201922 . This is a "JOHN HOPKINS/PRIORITY PARTNERS, UNIFORMED SERVICES FAMILY HEALTH/EMPLOYER HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7278 . This is a "BRAVO/ELDER HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 002XD . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3175526 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 415343000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00645864 AND DN9160 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".