Provider Demographics
NPI:1952346116
Name:CHANG, EDITH
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8617
Mailing Address - Fax:614-685-5246
Practice Address - Street 1:1025 REFUGEE RD STE 250
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9861
Practice Address - Country:US
Practice Address - Phone:614-293-8617
Practice Address - Fax:614-685-5246
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-7141 C207Q00000X
OH35.067141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0460362Medicaid
OH0460362Medicaid