Healthcare Provider Details

I. General information

NPI: 1255502092
Provider Name (Legal Business Name): CHUNTUNG CHANGCHIEN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8824 CUNNINGHAM DR SUITE E
BERWYN HEIGHTS MD
20740-2338
US

IV. Provider business mailing address

8824 CUNNINGHAM DR SUITE E
BERWYN HEIGHTS MD
20740-2338
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-5311
  • Fax: 301-982-5065
Mailing address:
  • Phone: 301-345-5311
  • Fax: 301-982-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0018852
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0018852
License Number StateMD

VIII. Authorized Official

Name: CATHY CHANGCHIEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-345-5311