Provider Demographics
NPI:1487846705
Name:CHANG, SUSAN S (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:915 OLD FERN HILL RD
Mailing Address - Street 2:BLDG B, SUITE 201
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4269
Mailing Address - Country:US
Mailing Address - Phone:610-436-6696
Mailing Address - Fax:
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:BLDG B, SUITE 201
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-436-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD424971208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA82767AMedicare PIN