Provider Demographics
NPI:1760640791
Name:CHANG, ANDREW J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
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 1:3821 ED DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8038
Mailing Address - Country:US
Mailing Address - Phone:919-863-9441
Mailing Address - Fax:919-863-9442
Practice Address - Street 1:3821 ED DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8038
Practice Address - Country:US
Practice Address - Phone:919-758-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201902815208800000X
MO2012010357208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD336222100Medicaid
MD293454YZUMedicare PIN