Provider Demographics
NPI:1609929801
Name:BISHOP, MARY ANN LANGE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:LANGE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Suffix:
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Mailing Address - Street 1:9808 LOG HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20882-2704
Mailing Address - Country:US
Mailing Address - Phone:301-540-3555
Mailing Address - Fax:
Practice Address - Street 1:7 METROPOLITAN CT STE 1
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-4016
Practice Address - Country:US
Practice Address - Phone:240-773-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037504207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E57000Medicare UPIN