Provider Demographics
NPI:1518329200
Name:LANGE, SARA MARIE (DO)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARIE
Last Name:LANGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2612
Mailing Address - Country:US
Mailing Address - Phone:315-945-3321
Mailing Address - Fax:
Practice Address - Street 1:PENN HIGHLANDS LIFE'S JOURNEY 190 WEST PARK AVE.
Practice Address - Street 2:SUITE 9
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2277
Practice Address - Country:US
Practice Address - Phone:814-371-1900
Practice Address - Fax:814-503-8568
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS020713207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program