Provider Demographics
NPI:1013729342
Name:LANGE, MARIA (DOM, AP, MS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:DOM, AP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 W LAKE MARY BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3461
Mailing Address - Country:US
Mailing Address - Phone:407-322-4963
Mailing Address - Fax:
Practice Address - Street 1:3525 W LAKE MARY BLVD STE 304
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3461
Practice Address - Country:US
Practice Address - Phone:407-322-4963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1631171100000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No171100000XOther Service ProvidersAcupuncturist