Provider Demographics
NPI:1518910769
Name:CHANG, MARVIN CLINTON (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:CLINTON
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 1:16605 SOUTHWEST FWY STE 550
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3792
Mailing Address - Country:US
Mailing Address - Phone:281-201-8818
Mailing Address - Fax:713-337-7261
Practice Address - Street 1:16605 SOUTHWEST FWY STE 550
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3792
Practice Address - Country:US
Practice Address - Phone:281-201-8818
Practice Address - Fax:713-337-7261
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6108208VP0000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085716101Medicaid
TXTXB131501Medicare PIN
TXTXB131502Medicare PIN
E35084Medicare UPIN