1427094234 NPI number — DAVID P CHODIRKER MD

Table of content: (NPI 1427094234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427094234 NPI number — DAVID P CHODIRKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID P CHODIRKER MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DBA FAMILY CARE ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427094234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
173 WORCESTER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLESLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02481-5521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-235-7900
Provider Business Mailing Address Fax Number:
781-237-9930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
173 WORCESTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLESLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02481-5521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-235-7900
Provider Business Practice Location Address Fax Number:
781-237-9930
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHODIRKER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PHYSICIAN SOLE PROPRIETOR
Authorized Official Telephone Number:
781-235-7900

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  74617 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4199853 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 487784800 . This is a "US DEPT OF LABOR WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1972504504 . This is a "NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0452115 . This is a "AETNA US HEALTHCARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34586 . This is a "FALLON COMMUNITY HP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71194 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: J11610 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0103579 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3084884 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74617 . This is a "MEDICAL LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 074617 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: M18640 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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