Basic Information
| Provider Information | |||||||||
| NPI: | 1275577843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 774 CHRISTIANA RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197134248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023550005 | ||||||||
| FaxNumber: | 3027096160 | ||||||||
| Practice Location | |||||||||
| Address1: | 774 CHRISTIANA RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197134236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234004 | ||||||||
| FaxNumber: | 3026234064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C10004311 | DE | N | Other Service Providers | Specialist | 208200000X | C10004311 | DE | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0000562701 | 05 | DE | MEDICAID |