Provider Demographics
NPI:1235691205
Name:CHANG, MARIANA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-276-7147
Mailing Address - Fax:
Practice Address - Street 1:577 PROSPECT AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6074
Practice Address - Country:US
Practice Address - Phone:718-369-0318
Practice Address - Fax:718-369-0290
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329246207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07909497Medicaid
NYA400358353OtherMEDICARE