Provider Demographics
NPI:1700807567
Name:CHANG, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:CHANG
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 1:402 WOODHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2958
Mailing Address - Country:US
Mailing Address - Phone:401-463-9158
Mailing Address - Fax:
Practice Address - Street 1:934 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2708
Practice Address - Country:US
Practice Address - Phone:401-941-3166
Practice Address - Fax:401-941-3122
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI06631208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7001847Medicaid
RI7001847Medicaid
RI007058721Medicare PIN