Provider Demographics
NPI:1760484398
Name:CHANG, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
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 1:8860 COLUMBIA 100 PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2195
Mailing Address - Country:US
Mailing Address - Phone:410-740-9330
Mailing Address - Fax:410-740-9335
Practice Address - Street 1:8860 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2195
Practice Address - Country:US
Practice Address - Phone:410-740-9330
Practice Address - Fax:410-740-9335
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7990899OtherAETNA PIN
MDI34551Medicare UPIN
7990899OtherAETNA PIN