Healthcare Provider Details

I. General information

NPI: 1578503512
Provider Name (Legal Business Name): CHITTARANJAN PRASAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NOTT ST
SCHENECTADY NY
12308-2425
US

IV. Provider business mailing address

17 ALVA RD
NISKAYUNA NY
12309-1176
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-4121
  • Fax: 518-372-2810
Mailing address:
  • Phone: 518-372-2807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number176726-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: