Provider Demographics
NPI:1801825393
Name:CHANG, CHI-KUE TONY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHI-KUE
Middle Name:TONY
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3508 NICHOLSON RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020
Mailing Address - Country:US
Mailing Address - Phone:484-241-9579
Mailing Address - Fax:610-882-3510
Practice Address - Street 1:3508 NICHOLSON RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020
Practice Address - Country:US
Practice Address - Phone:484-241-9579
Practice Address - Fax:610-882-3510
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047639L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP3172646OtherOXFORD
PACH038530OtherHIGHMARK BLUE SHIELD
PA0012959950002Medicaid
PA01017401/02344200OtherCAPITAL BLUE CROSS
PACH038530OtherPERSONAL CHOICE
PAP3172646OtherOXFORD
PA01017401/02344200OtherCAPITAL BLUE CROSS