Provider Demographics
NPI:1912907593
Name:CHOI, CHANG B (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:B
Last Name:CHOI
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:PO BOX 64916
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4916
Mailing Address - Country:US
Mailing Address - Phone:410-216-6481
Mailing Address - Fax:410-280-6515
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061783207R00000X
VA0101262334208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
64275401OtherBCBS-MD
0025OtherCAREFIRST BCBS
MD405721000Medicaid
7470776OtherAETNA
1194607OtherAETNA
405721000OtherAMERIGROUP - AMERICAID
0039732900OtherFEDERAL BLACK LUNG BENEFITS
122012OtherJHHC
0025OtherBCBS-DC
AH01OtherENVOY SITE ID
691L J719Medicare PIN
1194607OtherAETNA