Provider Demographics
NPI:1104941947
Name:CHANG PITTER, JEANNIE Y (MD)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:Y
Last Name:CHANG PITTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:Y,
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 744787
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4787
Mailing Address - Country:US
Mailing Address - Phone:202-833-4543
Mailing Address - Fax:202-833-8977
Practice Address - Street 1:2021 K ST NW STE 800
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1008
Practice Address - Country:US
Practice Address - Phone:202-833-4543
Practice Address - Fax:202-833-8977
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036485208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics