Provider Demographics
NPI:1700923273
Name:DELANGE, TYLER CAMERON (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:CAMERON
Last Name:DELANGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4861
Mailing Address - Country:US
Mailing Address - Phone:443-604-4642
Mailing Address - Fax:
Practice Address - Street 1:1830 E MONUMENT ST STE 6-111
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2100
Practice Address - Country:US
Practice Address - Phone:410-955-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT4197207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine