Provider Demographics
NPI:1528089588
Name:FENG, CHANG J (MD)
Entity type:Individual
Prefix:DR
First Name:CHANG
Middle Name:J
Last Name:FENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 KEISLER DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7091
Mailing Address - Country:US
Mailing Address - Phone:919-803-0813
Mailing Address - Fax:919-803-0967
Practice Address - Street 1:251 KEISLER DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7091
Practice Address - Country:US
Practice Address - Phone:919-803-0813
Practice Address - Fax:919-803-0967
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400328207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136PXOtherBC
NC89136PXMedicaid
NC136PXOtherBC
NC2032801AMedicare ID - Type Unspecified