Provider Demographics
NPI:1568535524
Name:CHANG, LIE PING (DO)
Entity Type:Individual
Prefix:DR
First Name:LIE PING
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 DUKE STREET
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4522
Mailing Address - Country:US
Mailing Address - Phone:703-823-6016
Mailing Address - Fax:703-370-1144
Practice Address - Street 1:3315 DUKE STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4522
Practice Address - Country:US
Practice Address - Phone:703-823-6016
Practice Address - Fax:703-370-1144
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102034648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C88879Medicare UPIN
223178Medicare ID - Type Unspecified