Individual
THEODORE T CHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
319 S MANNING BLVD, SUITE 106, ALBANY, NY 12208-1742
(518) 438-1019
(518) 438-0981
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
204809
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00406922007
BLUE SHIELD NORTHEASTERN
NY
01
—
10002480
CAPITAL DISTRICT PHYSICIA
NY
01
—
1099057
GHI PPO
NY
01
—
24134
MOHAWK VALLEY PHYSICIANS
NY
01
—
92950
GHI HMO
NY
01
—
P00291584
RAILROAD MEDICARE
NY
Enumeration date
05/12/2006
Last updated
08/27/2024
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