Provider Demographics
NPI:1124032750
Name:CHANG, AMY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
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 1:722 YORKLYN RD
Mailing Address - Street 2:STONE MILL OFFICE PARK, SUITE 100
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707
Mailing Address - Country:US
Mailing Address - Phone:302-235-1188
Mailing Address - Fax:302-239-2604
Practice Address - Street 1:722 YORKLYN RD
Practice Address - Street 2:STONE MILL OFFICE PARK, SUITE 100
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707
Practice Address - Country:US
Practice Address - Phone:302-235-1188
Practice Address - Fax:302-239-2604
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006480208000000X
NJ25-MA-07452300208000000X
PAMD-423599208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012338790001Medicaid
491764Medicare ID - Type Unspecified
I08737Medicare UPIN