Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 242142 | MA |
NPI | 1013941350 |
---|---|
Provider Name | Dr. Kara Deaver Chang |
First Address | Wellesley, MA 02481-1905 |
Second Address | Wellesley, MA 02481-1905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 21/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01620273 | BLUE CROSS BLUE SHIELD (01) | IL |