Healthcare Provider Details

I. General information

NPI: 1487668943
Provider Name (Legal Business Name): EFFIE C CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 SHERMAN AVE STE 302
NEW HAVEN CT
06511
US

IV. Provider business mailing address

136 SHERMAN AVE STE 302
NEW HAVEN CT
06511
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:
Title or Position:
Credential:
Phone: