Provider Demographics
NPI:1891787479
Name:DRANGE, MARLYS R (MD,PHD)
Entity Type:Individual
Prefix:
First Name:MARLYS
Middle Name:R
Last Name:DRANGE
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 VERDUGO BLVD # 781
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1626
Mailing Address - Country:US
Mailing Address - Phone:626-795-2663
Mailing Address - Fax:973-425-5657
Practice Address - Street 1:301 S FAIR OAKS AVE STE 105
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2536
Practice Address - Country:US
Practice Address - Phone:626-795-2663
Practice Address - Fax:626-795-2012
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54654207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00101088OtherRAILROAD BOARD PROVIDER #
CA00A546540OtherBLUE SHIELD OF CA PROVIDE
CA7923140OtherAETNA PROVIDER #
CAH00040Medicare UPIN
CAP00101088OtherRAILROAD BOARD PROVIDER #