Provider Demographics
NPI:1508904772
Name:CANGE, DARLYNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DARLYNE
Middle Name:
Last Name:CANGE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1606
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-1606
Mailing Address - Country:US
Mailing Address - Phone:410-733-4770
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY STE 404
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3082
Practice Address - Country:US
Practice Address - Phone:410-733-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001068213ES0131X
FLPO3100213ES0131X
MD01457213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415343000Medicaid
MD9443167OtherAETNA
MD3175526OtherUNITED HEALTH CARE
MD002XDOtherCARE FIRST BC/BS(MARYLAND PARTICIPATING PROVIDER-CAREFIRST OF MARYLAND)
MD7278OtherBRAVO/ELDER HEALTH
MDD364OtherCARE FIRST BC/BS (GHMSI PARTICIPATING PROVIDER-BLUE CHOICE)
MD018750060OtherMARYLAND PHYSICIAN CARE
MD9443167OtherAETNA
MD018750060OtherMARYLAND PHYSICIAN CARE