Provider Demographics
NPI:1457477978
Name:ANGE, CONSTANCE E (DO)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:E
Last Name:ANGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 LYONS RD # G
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1818
Mailing Address - Country:US
Mailing Address - Phone:937-438-0068
Mailing Address - Fax:
Practice Address - Street 1:1255 LYONS RD # G
Practice Address - Street 2:
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45458-1818
Practice Address - Country:US
Practice Address - Phone:937-438-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0023592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH#B-96591Medicare UPIN