Provider Demographics
NPI:1063426617
Name:CHANG, ROSEMARIE S W (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:S W
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST STE 515
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1072
Mailing Address - Country:US
Mailing Address - Phone:808-951-6006
Mailing Address - Fax:808-943-2634
Practice Address - Street 1:1319 PUNAHOU ST STE 515
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1072
Practice Address - Country:US
Practice Address - Phone:808-951-6006
Practice Address - Fax:808-943-2634
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 8574207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIG48597Medicare UPIN
HI50006Medicare ID - Type Unspecified