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General NPI Number Information
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NPI Number | 1558361048
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Entity Type | Individual
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Provider Name | FONG MEI CHANG M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 14153 YOSEMITE DR STE 202
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City | HUDSON
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State | FL
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Zip | 34667
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Country | US
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Telephone | 727-868-5404
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Fax | 727-863-1787
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Provider Business Mailing Address
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Address Line | 14153 YOSEMITE DR STE 202
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City | HUDSON
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State | FL
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Zip | 34667-6575
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Country | US
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Telephone | 727-868-5404
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Fax | 727-863-1787
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME0035346
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License Number State | FL
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