Provider Demographics
NPI:1487668943
Name:CHANG, EFFIE C (MD)
Entity Type:Individual
Prefix:
First Name:EFFIE
Middle Name:C
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 1:136 SHERMAN AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-776-5360
Mailing Address - Fax:203-787-4990
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:STE 302
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-776-5360
Practice Address - Fax:203-787-4990
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17026207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0468300001OtherDMERC
CT0468300001OtherMEDICARE NSC
010017026CT01OtherANTHEM BC
B38191Medicare UPIN
CT0468300001OtherDMERC