Provider Demographics
NPI:1386662591
Name:CHANG, VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
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 1:1425 PORTLAND AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-5525
Mailing Address - Fax:585-922-5526
Practice Address - Street 1:1299 PORTLAND AVE STE 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2727
Practice Address - Country:US
Practice Address - Phone:585-922-5520
Practice Address - Fax:585-922-5526
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158925208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01080006Medicaid
NY01080006Medicaid
NYAA1166Medicare PIN