Provider Demographics
NPI:1679557326
Name:CHANG, JOHN V (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:V
Last Name:CHANG
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-3188
Mailing Address - Country:US
Mailing Address - Phone:978-302-7300
Mailing Address - Fax:
Practice Address - Street 1:34 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2884
Practice Address - Country:US
Practice Address - Phone:978-686-0090
Practice Address - Fax:978-681-5963
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2020-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA56184207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB77094Medicare UPIN