Provider Demographics
NPI:1801960190
Name:CHANG, ROBERT Y (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:Y
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 1:35 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2023
Mailing Address - Country:US
Mailing Address - Phone:203-789-0425
Mailing Address - Fax:
Practice Address - Street 1:35 ELM STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2023
Practice Address - Country:US
Practice Address - Phone:203-789-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0353332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00135333Medicaid
CT035333OtherLISCENSE - CT
CT035333OtherLISCENSE - CT
CTR24574Medicare UPIN