Provider Demographics
NPI:1265548929
Name:CHANG, LAWRENCE K (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:K
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2117 GENERAL BOOTH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5803
Mailing Address - Country:US
Mailing Address - Phone:757-689-8183
Mailing Address - Fax:757-689-8783
Practice Address - Street 1:2117 GENERAL BOOTH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5803
Practice Address - Country:US
Practice Address - Phone:757-689-8783
Practice Address - Fax:757-689-8783
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101229875207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5900891Medicaid
VA5900891Medicaid
VAG90241Medicare UPIN