Healthcare Provider Details

I. General information

NPI: 1154605293
Provider Name (Legal Business Name): EFFIE C. CHANG, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 SHERMAN AVE SUITE 302
NEW HAVEN CT
06511-5238
US

IV. Provider business mailing address

136 SHERMAN AVE SUITE 302
NEW HAVEN CT
06511-5238
US

V. Phone/Fax

Practice location:
  • Phone: 203-776-5360
  • Fax: 203-787-4990
Mailing address:
  • Phone: 203-776-5360
  • Fax: 203-787-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number17026
License Number StateCT

VIII. Authorized Official

Name: DR. EFFIE C CHANG
Title or Position: OWNER
Credential: M.D., P.C.
Phone: 203-776-5360