Healthcare Provider Details

I. General information

NPI: 1225062755
Provider Name (Legal Business Name): BYUNG DOO CHANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CENTRE DR
NEW BLOOMFIELD PA
17068-9675
US

IV. Provider business mailing address

106 CENTRE DR P.O.BOX 356
NEW BLOOMFIELD PA
17068-9675
US

V. Phone/Fax

Practice location:
  • Phone: 717-582-2181
  • Fax: 717-582-3434
Mailing address:
  • Phone: 717-582-2181
  • Fax: 717-582-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD038287
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: