Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 243524 | MA |
N | 207VX0000X | Obstetrician | K1390 | TX |
NPI | 1407870389 |
---|---|
Provider Name | Ms. Mary C. Chang |
First Address | Amesbury, MA 01913-3530 |
Second Address | Haverhill, MA 01830-2659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 18/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039764802 | (05) | TX |
8P0851 | BC/BS (01) | TX |
G43150 | (02) | TX |
K1390 | STATE LICENSE (01) | TX |