Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD055882L | PA |
Y | 208600000X | Surgeon | MD055882L | PA |
N | 2086S0105X | Surgery of the Hand | MD055882L | PA |
NPI | 1043246820 |
---|---|
Provider Name | Benjamin Chang |
First Address | Philadelphia, PA 19104-5127 |
Second Address | Philadelphia, PA 19104-4306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015344590004 | (05) | PA |
F91067 | (02) |