1508904772 NPI number — DR. DARLYNE CANGE DPM

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508904772 NPI number — DR. DARLYNE CANGE DPM

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CANGE

Provider First Name:

DARLYNE

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

DPM

Provider Gender Code:

F

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:

1508904772

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/20/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 First Line Business Practice Location Address:

7310 RITCHIE HWY STE 404

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GLEN BURNIE

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21061-3082

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:

02/01/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 213ES0131X , with the licence number:  POD001068 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 213ES0131X , with the licence number: PO3100 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• 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" .

• Identifier: 415343000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 9443167 . This is a "AETNA" 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: 002XD . This is a "CARE FIRST BC/BS(MARYLAND PARTICIPATING PROVIDER-CAREFIRST OF MARYLAND)" 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: D364 . This is a "CARE FIRST BC/BS (GHMSI PARTICIPATING PROVIDER-BLUE CHOICE)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 018750060 . This is a "MARYLAND PHYSICIAN CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".