Provider Demographics
NPI:1922014786
Name:WOODY CHANG, M.D., P.C.
Entity Type:Organization
Organization Name:WOODY CHANG, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WOODY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-698-1997
Mailing Address - Street 1:3129 PROSPERITY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2819
Mailing Address - Country:US
Mailing Address - Phone:703-698-1997
Mailing Address - Fax:703-698-1933
Practice Address - Street 1:1934 OLD GALLOWS RD STE 350
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-4040
Practice Address - Country:US
Practice Address - Phone:703-698-1997
Practice Address - Fax:703-698-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH25369Medicare UPIN
VAG01631Medicare ID - Type Unspecified