Provider Demographics
NPI:1104053842
Name:CHANG, AMY PODOLSKI (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:PODOLSKI
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 1:328 SHREWSBURY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4613
Mailing Address - Country:US
Mailing Address - Phone:508-755-4861
Mailing Address - Fax:
Practice Address - Street 1:328 SHREWSBURY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4613
Practice Address - Country:US
Practice Address - Phone:508-755-4861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-21
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256324207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology