Provider Demographics
NPI:1245217496
Name:CHANG, PAUL ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDREW
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:PO BOX 3627
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-0627
Mailing Address - Country:US
Mailing Address - Phone:419-529-4100
Mailing Address - Fax:419-529-8700
Practice Address - Street 1:2558 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1209
Practice Address - Country:US
Practice Address - Phone:419-529-4100
Practice Address - Fax:419-529-8700
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078250C207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2192694Medicaid
OH2192694Medicaid
4027083Medicare PIN