Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 27504 | MD |
NPI | 1053970335 |
---|---|
Provider Name | Dr. Lucas Lin Chang |
First Address | Columbia, MD 21045-1990 |
Second Address | Columbia, MD 21045-1990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2019 |
Last Update Date | 07/07/2021 |