Healthcare Provider Details

I. General information

NPI: 1750302279
Provider Name (Legal Business Name): MICHAEL CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COLLEGE ST
RICHMOND VA
23298-5017
US

IV. Provider business mailing address

PO BOX 980058 401 COLLEGE AVE, DEPT RADIATION ONCOLOGY
RICHMOND VA
23298-0058
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7232
  • Fax:
Mailing address:
  • Phone: 804-828-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101057886
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: