Provider Demographics
NPI:1770651416
Name:CHANG, CORINNA Y (MD)
Entity Type:Individual
Prefix:
First Name:CORINNA
Middle Name:Y
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 1:6600 LOCKHART LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8022
Mailing Address - Country:US
Mailing Address - Phone:614-389-2968
Mailing Address - Fax:
Practice Address - Street 1:5156 BLAZER PKWY
Practice Address - Street 2:STE 120
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7317
Practice Address - Country:US
Practice Address - Phone:614-791-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010717542085R0202X
OH0954472085R0202X
NC1553052085R0202X
TNMD00000447682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26008OtherBCBS OF MICHIGAN
0Q26008OtherBCN
0Q26008069OtherRR MEDICARE
MI4977934Medicaid
0Q26008069OtherFEDERAL BLACK LUNG
0Q26008069OtherFEDERAL BLACK LUNG
0Q26008069OtherRR MEDICARE
MI0Q26008069Medicare ID - Type Unspecified
MI4977934Medicaid