Basic Information
| Provider Information | |||||||||
| NPI: | 1427053370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CHUN-LU | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 757 NORLAND AVENUE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176870 | ||||||||
| FaxNumber: | 7172176945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 01/06/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MD425419 | PA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207YP0228X | MD425419 | PA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology | 207YS0123X | MD425419 | PA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YX0007X | MD425419 | PA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck | 207YX0901X | MD425419 | PA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology |
ID Information
| ID | Type | State | Issuer | Description | 120420405 | 01 | PA | DEPT OF LABOR | OTHER | 161083 | 01 | PA | UNISON | OTHER | 2138338 | 01 | PA | FIRST HEALTH | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 1544525 | 01 | PA | GATEWAY | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 426713 | 01 | PA | HEALTH AMERICA | OTHER | G920-0039/647200-02 | 01 | PA | CAREFIRST | OTHER | 101236084 0001 | 05 | PA | MEDICAID | 2129690 | 01 | PA | MAMSI | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | MD425419 | 01 | PA | LICENSE | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 25-1716306 | 01 | PA | GREATWEST | OTHER | 50044493 | 01 | PA | CAPITAL BLUECROSS | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 3698774 | 01 | PA | AETNA HMO | OTHER | P00222626 | 01 | PA | RAILROAD MEDICARE | OTHER | 7615333 | 01 | PA | AETNA NON-HMO | OTHER | BC6904836 | 01 | PA | DEA | OTHER | CH1658644 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |