Healthcare Provider Details

I. General information

NPI: 1104941947
Provider Name (Legal Business Name): JEANNIE Y. CHANG PITTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNIE Y, CHANG MD

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW STE 800
WASHINGTON DC
20006-1008
US

IV. Provider business mailing address

PO BOX 744787
ATLANTA GA
30374-4787
US

V. Phone/Fax

Practice location:
  • Phone: 202-833-4543
  • Fax: 202-833-8977
Mailing address:
  • Phone: 202-833-4543
  • Fax: 202-833-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD036485
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: