Provider Demographics
NPI:1932179637
Name:CHANG, LENNIG WILFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:LENNIG
Middle Name:WILFRED
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-964-8497
Mailing Address - Fax:617-964-8479
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 405
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-964-8497
Practice Address - Fax:617-964-8479
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA31068207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA700149OtherTUFTS HEALTH PLAN
MAC16061Medicare PIN
D82792Medicare UPIN