Provider Demographics
NPI:1679581342
Name:CHANG, HOWARD H (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:H
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-2051
Mailing Address - Country:US
Mailing Address - Phone:508-427-2525
Mailing Address - Fax:
Practice Address - Street 1:235 N PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1794
Practice Address - Country:US
Practice Address - Phone:508-427-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA719832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0025169OtherNEIGHBORHOOD HEALTH PLAN
MA24161OtherHEALTHNET
MA772097OtherTUFTS
MA3077039Medicaid
MAJ11166OtherBLUE CROSS
MA3077039Medicaid
MAE85591Medicare UPIN
MA260029036Medicare PIN