Provider Demographics
NPI:1780768705
Name:CHANG, STEWART MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:MICHAEL
Last Name:CHANG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 CLEAR SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7219
Mailing Address - Country:US
Mailing Address - Phone:434-974-7077
Mailing Address - Fax:434-979-8880
Practice Address - Street 1:887 RIO EAST CT # A
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8004
Practice Address - Country:US
Practice Address - Phone:434-979-8116
Practice Address - Fax:434-979-8880
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300932213EP1101X, 213ES0103X, 213E00000X, 213ES0000X, 213ER0200X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA179774OtherANTHEM - W'BORO OFFICE
VA2132454OtherMAMSI
VA6661192OtherCIGNA
VA010193133Medicaid
VA2132454OtherALLIANCE
VA306352OtherSOUTHERN HEALTH
VA010151503Medicaid
VA179769OtherANTHEM - C'VILLE OFFICE
VA7412732OtherAETNA
VAV05241Medicare UPIN
VA2132454OtherMAMSI
VA179769OtherANTHEM - C'VILLE OFFICE