Provider Demographics
NPI:1306889357
Name:CHOCKALINGAM, SELVAKUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SELVAKUMAR
Middle Name:
Last Name:CHOCKALINGAM
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 1:1400 PORTLAND AVE
Mailing Address - Street 2:SUITE 31
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3014
Mailing Address - Country:US
Mailing Address - Phone:585-342-7090
Mailing Address - Fax:585-342-7099
Practice Address - Street 1:1400 PORTLAND AVE
Practice Address - Street 2:SUITE 31
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3014
Practice Address - Country:US
Practice Address - Phone:585-342-7090
Practice Address - Fax:585-342-7099
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189338207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106258BOOtherPREFERRED CARE