Provider Demographics
NPI:1639159825
Name:CHANG, MONA PINGHUA (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:PINGHUA
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 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1205 RIVER AVE FL 2
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3724
Practice Address - Country:US
Practice Address - Phone:570-326-4118
Practice Address - Fax:570-326-5533
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044123E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA461985F6KOtherMEDICARE PTAN
PA0011677070001Medicaid
PA70296-C241OtherGEISINGER
PA080022907OtherPALMETTO/MC RAILROAD
PAE21949Medicare UPIN
PA232175463OtherAETNA
PA461985D6YMedicare PIN
PA461985OtherHIGHMARK BLUE SHIELD
PA002483OtherFIRST PRIORITY HEALTH