Provider Demographics
NPI:1336149103
Name:OH, CHANG WHA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:WHA
Last Name:OH
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 1:300 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-4871
Mailing Address - Country:US
Mailing Address - Phone:717-273-8835
Mailing Address - Fax:717-202-0100
Practice Address - Street 1:300 WILLOW ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-4871
Practice Address - Country:US
Practice Address - Phone:717-273-8835
Practice Address - Fax:717-202-0100
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028832E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34901Medicare UPIN