Provider Demographics
NPI:1851316111
Name:CHANG, JAMISON W (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMISON
Middle Name:W
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5034 OLD CLINIC BUILDING CB 7110
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7110
Mailing Address - Country:US
Mailing Address - Phone:984-974-1931
Mailing Address - Fax:984-974-2216
Practice Address - Street 1:5034 OLD CLINIC BUILDING CB 7110
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7110
Practice Address - Country:US
Practice Address - Phone:984-974-1931
Practice Address - Fax:984-974-2216
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20041620208M00000X
NC200401620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901054Medicaid
NC2047971Medicare ID - Type Unspecified
NCI45206Medicare UPIN
NC5901054Medicaid