Provider Demographics
NPI:1649299561
Name:LANGE, MARY E (NP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:LANGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:DOHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:STE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3736
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:94 MENDON RD
Practice Address - Street 2:PRE- ADMISSION TESTING
Practice Address - City:HOPEDALE
Practice Address - State:MA
Practice Address - Zip Code:01747-1311
Practice Address - Country:US
Practice Address - Phone:508-482-5401
Practice Address - Fax:508-482-5402
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203848363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0706001Medicaid
MAUX7265Medicare PIN
MA0706001Medicaid