Provider Demographics
NPI:1225495906
Name:CHANG, MARIE A
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:A
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 DUPONT PL
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6474
Mailing Address - Country:US
Mailing Address - Phone:561-793-7040
Mailing Address - Fax:561-793-7040
Practice Address - Street 1:9046 DUPONT PL
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6474
Practice Address - Country:US
Practice Address - Phone:561-793-7040
Practice Address - Fax:561-793-7040
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor