Healthcare Provider Details

I. General information

NPI: 1023287331
Provider Name (Legal Business Name): LAWRENCE D CHANG M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA ROAD SUITE 101
NEWARK DE
19713
US

IV. Provider business mailing address

774 CHRISTIANA ROAD SUITE 101
NEWARK DE
19713
US

V. Phone/Fax

Practice location:
  • Phone: 302-355-0005
  • Fax: 302-709-6161
Mailing address:
  • Phone: 302-355-0005
  • Fax: 302-709-6161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberC10004311
License Number StateDE

VIII. Authorized Official

Name: MRS. THERESA BOLTE
Title or Position: BILLING
Credential:
Phone: 302-355-0005