Provider Demographics
NPI:1871653196
Name:CHANG, JAMES C (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
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 1:7053 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1114
Mailing Address - Country:US
Mailing Address - Phone:419-843-1370
Mailing Address - Fax:419-843-8402
Practice Address - Street 1:7053 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1114
Practice Address - Country:US
Practice Address - Phone:419-843-1370
Practice Address - Fax:419-843-8402
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046488208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0709513Medicaid
OHSP02191Medicare ID - Type UnspecifiedMEDICARE SOLE PROVIDER
OH4223442Medicare PIN
OH9282354Medicare PIN
OH0709513Medicaid
OH9282351Medicare PIN