Provider Demographics
NPI:1659571743
Name:CHANG, WOODY (MD)
Entity Type:Individual
Prefix:DR
First Name:WOODY
Middle Name:
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 1:3129 PROSPERITY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2819
Mailing Address - Country:US
Mailing Address - Phone:703-698-1997
Mailing Address - Fax:703-698-1933
Practice Address - Street 1:1934 OLD GALLOWS RD STE 350
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-4050
Practice Address - Country:US
Practice Address - Phone:703-698-1997
Practice Address - Fax:703-698-1933
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH25369Medicare UPIN