Healthcare Provider Details

I. General information

NPI: 1700923273
Provider Name (Legal Business Name): TYLER CAMERON DELANGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 E MONUMENT ST STE 6-111
BALTIMORE MD
21205-2100
US

IV. Provider business mailing address

2904 ELLIOTT ST
BALTIMORE MD
21224-4861
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-3380
  • Fax:
Mailing address:
  • Phone: 443-604-4642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT4197
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: