MEDICARE: DR. MARILYN M LANGE MARILYN LANGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G25227	CA

General Provider Information

NPI Number	:	1427150226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN M LANGE MARILYN LANGE

Provider Business Mailing Address
First Line	:	10620 RIVERSIDE DR
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91602-2373
Country	:	US
Telephone Number	:	818-980-0011
Fax Number	:

Provider Business Practice Location Address
First Line	:	10620 RIVERSIDE DR
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91602-2373
Country	:	US
Telephone Number	:	818-980-0011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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