Provider Demographics
NPI:1427150226
Name:LANGE, MARILYN M (MARILYN LANGE)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:M
Last Name:LANGE
Suffix:
Gender:F
Credentials:MARILYN LANGE
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:M
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10620 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2373
Mailing Address - Country:US
Mailing Address - Phone:818-980-0011
Mailing Address - Fax:
Practice Address - Street 1:10620 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2373
Practice Address - Country:US
Practice Address - Phone:818-980-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25227208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics