Healthcare Provider Details

I. General information

NPI: 1003853508
Provider Name (Legal Business Name): SYLVIA S CHANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MIDDLESEX TPKE
BURLINGTON MA
01803-4945
US

IV. Provider business mailing address

513 CHESTNUT ST
WABAN MA
02468-1205
US

V. Phone/Fax

Practice location:
  • Phone: 781-635-5999
  • Fax:
Mailing address:
  • Phone: 443-632-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD63000
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number284241
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: