MEDICARE: CHUN S CHANG MD

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	2084P0800X	Psychiatry Physician	MD032584L	PA

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	:	1942294111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUN S CHANG MD

Provider Business Mailing Address
First Line	:	41 DORCHESTER DR
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-1401
Country	:	US
Telephone Number	:	570-552-6195
Fax Number	:	570-552-6020

Provider Business Practice Location Address
First Line	:	41 DORCHESTER DR
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-1401
Country	:	US
Telephone Number	:	570-552-6195
Fax Number	:	570-552-6020

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	03/11/2014

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Directions to “ CHUN S CHANG MD” Practice Location

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