Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 205830 | MA |
N | 208600000X | Surgeon | 205830 | MA |
N | 2086S0129X | Vascular Surgeon | 205830 | MA |
NPI | 1003884164 |
---|---|
Provider Name | Dr. Jeanette K Chang |
First Address | Stoneham, MA 02180-3623 |
Second Address | Stoneham, MA 02180-3623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0195791 | (05) | MA |
H62651 | (02) | MA |
J24951 | BCBS (01) | MA |