Healthcare Provider Details

I. General information

NPI: 1952466476
Provider Name (Legal Business Name): PAUL A. CHANG, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 12/19/2018
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
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 Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. PAUL A CHANG
Title or Position: OWNER
Credential: M.D.
Phone: 419-529-4100