Basic Information
| Provider Information | |||||||||
| NPI: | 1780768705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | STEWART | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3075 CLEAR SPRINGS CT | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229117219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349747077 | ||||||||
| FaxNumber: | 4349798880 | ||||||||
| Practice Location | |||||||||
| Address1: | 887 RIO EAST CT # A | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229018004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349798116 | ||||||||
| FaxNumber: | 4349798880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 05/02/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | 0103300932 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0103X | 0103300932 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213E00000X | 0103300932 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0000X | 0103300932 | VA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | 213ER0200X | 0103300932 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Radiology | 213ES0131X | 0103300932 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 179774 | 01 | VA | ANTHEM - W'BORO OFFICE | OTHER | 2132454 | 01 | VA | MAMSI | OTHER | 6661192 | 01 | VA | CIGNA | OTHER | 010193133 | 05 | VA | MEDICAID | 2132454 | 01 | VA | ALLIANCE | OTHER | 306352 | 01 | VA | SOUTHERN HEALTH | OTHER | 010151503 | 05 | VA | MEDICAID | 179769 | 01 | VA | ANTHEM - C'VILLE OFFICE | OTHER | 7412732 | 01 | VA | AETNA | OTHER |