MEDICARE: DR. CLAYTON W CHANG M.D

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	207R00000X	Internal Medicine Physician	MD024824E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0045917000	OTHER	PA	KEYSTONE INS

General Provider Information

NPI Number	:	1346204328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAYTON W CHANG M.D

Provider Business Mailing Address
First Line	:	933 N CHARLOTTE ST
Second Line	:	SUITE 101
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-3974
Country	:	US
Telephone Number	:	610-323-6566
Fax Number	:	610-323-9267

Provider Business Practice Location Address
First Line	:	933 N CHARLOTTE ST
Second Line	:	SUITE 101
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-3974
Country	:	US
Telephone Number	:	610-323-6566
Fax Number	:	610-323-9267

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	09/13/2011

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