Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0103300932 | VA |
N | 222Z00000X | Podiatrist | 0103300932 | VA |
N | 213EP1101X | Primary Podiatric Medicine | 0103300932 | VA |
N | 111NR0200X | Radiology | 0103300932 | VA |
N | 213ER0200X | Radiology | 0103300932 | VA |
Y | 2081S0010X | Sports Medicine | 0103300932 | VA |
Y | 213ES0000X | Sports Medicine | 0103300932 | VA |
N | 213ES0103X | Foot & Ankle Surgery | 0103300932 | VA |
N | 213ES0131X | Foot Surgery | 0103300932 | VA |
NPI | 1780768705 |
---|---|
Provider Name | Stewart Michael Chang |
First Address | Charlottesville, VA 22911-7219 |
Second Address | Charlottesville, VA 22901-8004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 02/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010151503 | (05) | VA |
010193133 | (05) | VA |
179769 | ANTHEM - C'VILLE OFFICE (01) | VA |
179774 | ANTHEM - W'BORO OFFICE (01) | VA |
2132454 | ALLIANCE (01) | VA |
2132454 | MAMSI (01) | VA |
306352 | SOUTHERN HEALTH (01) | VA |
6661192 | CIGNA (01) | VA |
7412732 | AETNA (01) | VA |
V05241 | (02) | VA |