Provider Demographics
NPI:1275577843
Name:CHANG, LAWRENCE D (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:D
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:774 CHRISTIANA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4248
Mailing Address - Country:US
Mailing Address - Phone:302-355-0005
Mailing Address - Fax:302-709-6160
Practice Address - Street 1:774 CHRISTIANA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4236
Practice Address - Country:US
Practice Address - Phone:302-623-4004
Practice Address - Fax:302-623-4064
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004311174400000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000562701Medicaid
DE000L10P59Medicare ID - Type Unspecified
DE0000562701Medicaid