Provider Demographics
NPI:1043279094
Name:CHANG, RUBY (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBY
Middle Name:
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 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4109
Mailing Address - Country:US
Mailing Address - Phone:413-447-2752
Mailing Address - Fax:413-496-6836
Practice Address - Street 1:100 MAPLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1963
Practice Address - Country:US
Practice Address - Phone:413-528-4047
Practice Address - Fax:413-528-3407
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51560208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA201051OtherPILGRIM
MAJ05529OtherBCBS
MA3008835Medicaid
MA010051560MA01OtherBCBC CONN
MA11199OtherHEALTH NEW ENGLAND
MA7859OtherHEALTHNET
MA515600OtherCONNECTICARE