MEDICARE: DR. STEPHEN W. CHANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	246121	NY
2	174400000X	Specialist	246121	NY
3	2085R0202X	Diagnostic Radiology Physician	0101242425	VA
4	2085R0202X	Diagnostic Radiology Physician	25MA09064100	NJ

General Provider Information

NPI Number	:	1578721593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN W. CHANG M.D.

Provider Business Mailing Address
First Line	:	1980 GALLOWS RD
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1980 GALLOWS RD
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-3913
Country	:	US
Telephone Number	:	703-356-9899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	10/17/2013

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