Provider Demographics
NPI:1902849466
Name:CHANG, MATTHEW S (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:SUITE 170 - GENERAL SURGERY
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6626
Mailing Address - Country:US
Mailing Address - Phone:716-483-1183
Mailing Address - Fax:716-664-4903
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:SUITE 170
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6626
Practice Address - Country:US
Practice Address - Phone:716-483-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221303-01208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400168868OtherMEDICARE PTAN
NY2157940Medicaid
NY2157940Medicaid