Provider Demographics
NPI:1407870389
Name:CHANG, MARY C (DO)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:CHANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:24 MORRILL PL STE 2
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3530
Mailing Address - Country:US
Mailing Address - Phone:978-834-8074
Mailing Address - Fax:978-834-8077
Practice Address - Street 1:600 PRIMROSE ST STE 202
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2659
Practice Address - Country:US
Practice Address - Phone:978-556-1000
Practice Address - Fax:978-556-0094
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK1390207VX0000X
MA243524207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK1390OtherSTATE LICENSE
TX8P0851OtherBC/BS
TX039764802Medicaid
TX8P0851OtherBC/BS
TX8C0273Medicare ID - Type Unspecified