Healthcare Provider Details

I. General information

NPI: 1780768705
Provider Name (Legal Business Name): STEWART MICHAEL CHANG D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 RIO EAST CT # A
CHARLOTTESVILLE VA
22901-8004
US

IV. Provider business mailing address

3075 CLEAR SPRINGS CT
CHARLOTTESVILLE VA
22911-7219
US

V. Phone/Fax

Practice location:
  • Phone: 434-979-8116
  • Fax: 434-979-8880
Mailing address:
  • Phone: 434-974-7077
  • Fax: 434-979-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0103300932
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103300932
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103300932
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number0103300932
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number0103300932
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103300932
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: