MEDICARE: DR. LIE PING CHANG DO

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	207Q00000X	Family Medicine Physician	0102034648	VA

General Provider Information

NPI Number	:	1568535524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIE PING CHANG DO

Provider Business Mailing Address
First Line	:	3315 DUKE STREET
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4522
Country	:	US
Telephone Number	:	703-823-6016
Fax Number	:	703-370-1144

Provider Business Practice Location Address
First Line	:	3315 DUKE STREET
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4522
Country	:	US
Telephone Number	:	703-823-6016
Fax Number	:	703-370-1144

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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