Provider Demographics
NPI:1316671001
Name:KACHUR, STEPHEN PATRICK (MD)
Entity type:Individual
Prefix:PROF
First Name:STEPHEN
Middle Name:PATRICK
Last Name:KACHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S. PATRICK
Other - Middle Name:
Other - Last Name:KACHUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:870 RIVERSIDE DR APT 5G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-5473
Mailing Address - Country:US
Mailing Address - Phone:404-345-9615
Mailing Address - Fax:
Practice Address - Street 1:870 RIVERSIDE DR APT 5G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5473
Practice Address - Country:US
Practice Address - Phone:404-345-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00420662083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine