Provider Demographics
NPI:1134193097
Name:PEDIATRIC ASSOCIATES OF MALDEN, PC
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF MALDEN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIEN-LAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-322-5101
Mailing Address - Street 1:105 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5509
Mailing Address - Country:US
Mailing Address - Phone:781-322-5101
Mailing Address - Fax:781-322-5280
Practice Address - Street 1:105 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5509
Practice Address - Country:US
Practice Address - Phone:781-322-5101
Practice Address - Fax:781-322-5280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA43430OtherFALLON
MA683054OtherTUFTS HEALTH PLAN
MAM17324OtherBLUE CROSS BLUE SHIELD
MA101241OtherAETNA
MA9785973Medicaid