Healthcare Provider Details

I. General information

NPI: 1245217496
Provider Name (Legal Business Name): PAUL ANDREW CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2558 W 4TH ST
ONTARIO OH
44906-1209
US

IV. Provider business mailing address

PO BOX 3627
MANSFIELD OH
44907-0627
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-4100
  • Fax: 419-529-8700
Mailing address:
  • Phone: 419-529-4100
  • Fax: 419-529-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35078250C
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35078250C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: