Provider Demographics
NPI:1467471250
Name:CHANG, CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5409
Mailing Address - Country:US
Mailing Address - Phone:203-801-4318
Mailing Address - Fax:203-801-4324
Practice Address - Street 1:39 PINE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5409
Practice Address - Country:US
Practice Address - Phone:203-801-4318
Practice Address - Fax:203-801-4324
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038767207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT038767OtherCONNECTICARE
CT3184434OtherAETNA
CTP2109751OtherOXFORD HEALTH PLANS
CT2V3106OtherHEALTH NET
CT010038737CT02OtherANTHEM BC/BS
H28602Medicare UPIN