Provider Demographics
NPI:1164514485
Name:CHANG, VIRGINIA W (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:W
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 BLOCKLEY HALL
Mailing Address - Street 2:423 GUARDIAN DR.
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-6021
Mailing Address - Country:US
Mailing Address - Phone:215-573-0295
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-823-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine