Provider Demographics
NPI:1972686368
Name:CHANGCHIEN, CHUNTUNG (MD)
Entity Type:Individual
Prefix:
First Name:CHUNTUNG
Middle Name:
Last Name:CHANGCHIEN
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 1:8824 CUNNINGHAM DR STE E
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2338
Mailing Address - Country:US
Mailing Address - Phone:301-345-5311
Mailing Address - Fax:301-982-5065
Practice Address - Street 1:8824 CUNNINGHAM DR STE E
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2338
Practice Address - Country:US
Practice Address - Phone:301-345-5311
Practice Address - Fax:301-982-5065
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018852208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
B92991Medicare UPIN
051647Medicare ID - Type Unspecified