Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 169766 | NY |
Y | 2086S0129X | Vascular Surgeon | MD476246 | PA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 169766 | NY |
NPI | 1023008117 |
---|---|
Provider Name | Benjamin Bansun Chang |
First Address | Williamsport, PA 17701-1900 |
Second Address | Williamsport, PA 17701-3102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01022251 | (05) | NY |