Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 287043 | MA |
N | 2080P0216X | Pediatric Rheumatologist | MD454296 | PA |
NPI | 1437412756 |
---|---|
Provider Name | Joyce Chang |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 23/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1034751440001 | (05) | PA |
1034751440002 | (05) | PA |