Provider Demographics
NPI:1023287331
Name:LAWRENCE D CHANG M.D., PA
Entity type:Organization
Organization Name:LAWRENCE D CHANG M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-355-0005
Mailing Address - Street 1:774 CHRISTIANA ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-355-0005
Mailing Address - Fax:302-709-6161
Practice Address - Street 1:774 CHRISTIANA ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-355-0005
Practice Address - Fax:302-709-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004311208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00259OtherMEDICARE GROUP
DE0000562701Medicaid
DE0000562701Medicaid