Provider Demographics
NPI:1366438624
Name:CHANG, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:110 HARTWELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-3118
Mailing Address - Country:US
Mailing Address - Phone:781-890-1023
Mailing Address - Fax:
Practice Address - Street 1:110 HARTWELL AVE STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-3118
Practice Address - Country:US
Practice Address - Phone:781-890-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59606207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110046370AMedicaid
MA15256OtherHARVARD PILGRIM
MA059606OtherTUFTS ASSOCIATED HEALTH
MA449337OtherAETNA
MAJ07347OtherBLUE CROSS/BLUE SHIELD
MA0936628-001OtherCIGNA
MA059606OtherTUFTS ASSOCIATED HEALTH
MA15256OtherHARVARD PILGRIM