Basic Information
| Provider Information | |||||||||
| NPI: | 1407870389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 MORRILL PL STE 2 | ||||||||
| Address2: | |||||||||
| City: | AMESBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019133530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788348074 | ||||||||
| FaxNumber: | 9788348077 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 PRIMROSE ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | HAVERHILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018302659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785561000 | ||||||||
| FaxNumber: | 9785560094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 10/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | K1390 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207V00000X | 243524 | MA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | K1390 | 01 | TX | STATE LICENSE | OTHER | 8P0851 | 01 | TX | BC/BS | OTHER | 039764802 | 05 | TX | MEDICAID |