Provider Demographics
NPI:1427094234
Name:DAVID P CHODIRKER MD
Entity type:Organization
Organization Name:DAVID P CHODIRKER MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHODIRKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-235-7900
Mailing Address - Street 1:173 WORCESTER STREET
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5521
Mailing Address - Country:US
Mailing Address - Phone:781-235-7900
Mailing Address - Fax:781-237-9930
Practice Address - Street 1:173 WORCESTER STREET
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5521
Practice Address - Country:US
Practice Address - Phone:781-235-7900
Practice Address - Fax:781-237-9930
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID P CHODIRKER MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4199853OtherAETNA US HEALTHCARE
487784800OtherUS DEPT OF LABOR WORKERS
1972504504OtherNPI NUMBER
0452115OtherAETNA US HEALTHCARE HMO
34586OtherFALLON COMMUNITY HP
71194OtherHPHC
J11610OtherBCBS
0103579OtherCIGNA
MA3084884Medicaid
74617OtherMEDICAL LICENSE
074617OtherTUFTS
M18640OtherBCBS
MAE99151Medicare UPIN
MAJ11610Medicare PIN