Provider Demographics
NPI:1003853508
Name:CHANG, SYLVIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1205
Mailing Address - Country:US
Mailing Address - Phone:443-632-5610
Mailing Address - Fax:
Practice Address - Street 1:47 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4945
Practice Address - Country:US
Practice Address - Phone:781-635-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63000207Q00000X
MA284241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD102253OtherJOHNS HOPKINS EHP
MDKJ24GB/647103-01OtherCAREFIRST MARYLAND
MDS142/0019OtherCAREFIRST REGIONAL
MD102253OtherPRIORITY PARTNERS
MD1075803OtherAETNA HMO
MD408387300Medicaid
MD2822930OtherCIGNA
MDKJ24GB/P16885OtherCAREFIRST POS
MD7532160OtherAETNA NON HMO
MDS142/0019OtherCAREFIRST REGIONAL
H17050Medicare UPIN