Provider Demographics
NPI:1558417881
Name:CHANG, LARRY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WILLIAM
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:1717 E MONUMENT ST.
Practice Address - Street 2:THE PARK BUILDING, GROUND FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-2100
Practice Address - Country:US
Practice Address - Phone:410-955-1725
Practice Address - Fax:443-287-4173
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD64129207R00000X
MDD0064129207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD023187800Medicaid
MD156051YXUMedicare PIN
MD156051Y82Medicare PIN