Individual
DR. GORDON Y. W. CHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
BRYN MAWR HOSPITAL, 130 S. BRYN MAWR AVE., BRYN MAWR, PA 19010-3121
(610) 526-4618
(610) 526-9897
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
MD062069L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001684017
—
PA
05
—
02753551
—
NY
05
—
1717103
—
MD
05
—
6275001
—
NJ
05
—
64072739
—
KY
Enumeration date
10/26/2006
Last updated
09/08/2011
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