Provider Demographics
NPI:1851339154
Name:CHANG, BERNARD S (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:S
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 1:330 BROOKLINE AVE
Mailing Address - Street 2:COMPREHENSIVE EPILEPSY CENTER, KS-457
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-2889
Mailing Address - Fax:617-667-7919
Practice Address - Street 1:330 BROOKLINE AVENUE, KS-457
Practice Address - Street 2:COMPREHENSIVE EPILEPSY CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-2889
Practice Address - Fax:617-667-7919
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2132202084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology