Provider Demographics
NPI:1538312764
Name:DR. DARLYNE CANGE, DPM, LLC
Entity Type:Organization
Organization Name:DR. DARLYNE CANGE, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM/PODIATRIC PHYSICIAN & SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DARLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-733-4770
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 1:1701 EUTAW PL
Practice Address - Street 2:SUITE 140
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3765
Practice Address - Country:US
Practice Address - Phone:410-733-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01457213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD002XDOtherBLUE CROSS BLUE SHIELD OF MARYLAND
MD3175526OtherUNITED HEALTH CARE
MD9443167OtherAETNA
MD018750060OtherMARYLAND PHYSICIAN CARE
MD201922OtherJOHN HOPKINS/PRIORITY PARTNERS/EMPLOYER HEALTH/UNIFORMED SERVICES FAMILY HEALTH
MD415343000Medicaid
MDD364OtherBLUE CROSS BLUE SHIELD-GHMSI
MDP00645864 AND DN9160OtherRAILROAD MEDICARE
MD7278OtherBRAVO/ELDER HEALTH
MD6131880001Medicare NSC
MD128704Medicare UPIN