Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 0101272436 | VA |
NPI | 1043639487 |
---|---|
Provider Name | Dr. Eric Su-Ming Chang |
First Address | Stafford, VA 22554-6203 |
Second Address | Stafford, VA 22554-6203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 28/06/2021 |