Provider Demographics
NPI:1427123090
Name:CHAUHAN, BANSIDHAR M (MD)
Entity type:Individual
Prefix:
First Name:BANSIDHAR
Middle Name:M
Last Name:CHAUHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 DECATUR AVE
Mailing Address - Street 2:6
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-4219
Mailing Address - Country:US
Mailing Address - Phone:718-231-8686
Mailing Address - Fax:718-579-4836
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:8-20
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5000
Practice Address - Fax:718-579-4836
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY146256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01010571Medicaid
NY27F201Medicare ID - Type Unspecified
NYE17301Medicare UPIN