Provider Demographics
NPI:1851368872
Name:CHANG, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
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 1:106 IRVING ST NW STE 120
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2994
Mailing Address - Country:US
Mailing Address - Phone:202-877-6032
Mailing Address - Fax:202-877-3053
Practice Address - Street 1:106 IRVING ST NW STE 120
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2994
Practice Address - Country:US
Practice Address - Phone:202-877-6032
Practice Address - Fax:202-877-3053
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30881208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC026487300Medicaid
MD761302400Medicaid
DC026487300Medicaid
MD761302400Medicaid