Provider Demographics
NPI:1144244344
Name:CHANG, PHILEMON D (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILEMON
Middle Name:D
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-4001
Mailing Address - Country:US
Mailing Address - Phone:615-746-9533
Mailing Address - Fax:
Practice Address - Street 1:161 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-1636
Practice Address - Country:US
Practice Address - Phone:731-352-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17803207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507231Medicaid
TNP00643326OtherRAILROAD MEDICARE
TN3883884Medicaid
TN4192397OtherBCBS
TN1507231Medicaid
TN38838834Medicare PIN
TNE51014Medicare UPIN
TN3883884Medicare ID - Type UnspecifiedCOPPERHILL ER - EMCARE