Healthcare Provider Details

I. General information

NPI: 1568972115
Provider Name (Legal Business Name): ALDEN S CHANG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105 FRANKLIN SQUARE DR STE 209
BALTIMORE MD
21237-3958
US

IV. Provider business mailing address

9105 FRANKLIN SQUARE DR STE 209
BALTIMORE MD
21237-3958
US

V. Phone/Fax

Practice location:
  • Phone: 410-574-1330
  • Fax: 410-391-3343
Mailing address:
  • Phone: 443-605-9954
  • Fax: 410-391-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC006643
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: