MEDICARE: DR. DIANE CHANG M.D., PH.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	207R00000X	Internal Medicine Physician	MT193100	PA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207W00000X	Ophthalmology Physician	257294	NY
4	207W00000X	Ophthalmology Physician	D79306	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	416850ZFRZ	OTHER	MD	MEDICARE
3	416850ZZFXB	OTHER	MD	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588826168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE CHANG M.D., PH.D.

Provider Business Mailing Address
First Line	:	70 E 10TH ST APT 1F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-5105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 E 10TH ST APT 1F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-5105
Country	:	US
Telephone Number	:	212-673-5650
Fax Number	:

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

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	07/01/2015

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Directions to “ DR. DIANE CHANG M.D., PH.D.” Practice Location

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