Healthcare Provider Details

I. General information

NPI: 1316568918
Provider Name (Legal Business Name): HANNA CHANG MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4712
US

IV. Provider business mailing address

310 W LOSEY ST
SCOTT AFB IL
62225-5250
US

V. Phone/Fax

Practice location:
  • Phone: 307-295-3717
  • Fax:
Mailing address:
  • Phone: 618-256-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101275041
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101275041
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0101275041
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: