Basic Information
| Provider Information | |||||||||
| NPI: | 1043279094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | RUBY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134472752 | ||||||||
| FaxNumber: | 4134966836 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MAPLE AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GREAT BARRINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012301963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135284047 | ||||||||
| FaxNumber: | 4135283407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 08/29/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 51560 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 201051 | 01 | MA | PILGRIM | OTHER | J05529 | 01 | MA | BCBS | OTHER | 3008835 | 05 | MA | MEDICAID | 010051560MA01 | 01 | MA | BCBC CONN | OTHER | 11199 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 7859 | 01 | MA | HEALTHNET | OTHER | 515600 | 01 | MA | CONNECTICARE | OTHER |