Provider Demographics
NPI:1932164100
Name:CHANG, LIZA WAICHUN (MD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:WAICHUN
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:515 FAIRMOUNT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8518
Mailing Address - Country:US
Mailing Address - Phone:410-494-1355
Mailing Address - Fax:410-494-1361
Practice Address - Street 1:515 FAIRMOUNT AVE STE 340
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8522
Practice Address - Country:US
Practice Address - Phone:410-321-9108
Practice Address - Fax:410-321-9126
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD45873207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD122611900Medicaid
MDF79827Medicare UPIN
MD122611900Medicaid
MD070011013Medicare PIN
MD157676Medicare PIN
MDLD24Medicare PIN