Healthcare Provider Details

I. General information

NPI: 1346204328
Provider Name (Legal Business Name): CLAYTON W CHANG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 N CHARLOTTE ST SUITE 101
POTTSTOWN PA
19464-3974
US

IV. Provider business mailing address

933 N CHARLOTTE ST SUITE 101
POTTSTOWN PA
19464-3974
US

V. Phone/Fax

Practice location:
  • Phone: 610-323-6566
  • Fax: 610-323-9267
Mailing address:
  • Phone: 610-323-6566
  • Fax: 610-323-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD024824E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0045917000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE INS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: