Provider Demographics
NPI:1003226937
Name:PATTNAIK, PRIYAM (MD)
Entity Type:Individual
Prefix:
First Name:PRIYAM
Middle Name:
Last Name:PATTNAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 READE PL
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3947
Mailing Address - Country:US
Mailing Address - Phone:845-431-5677
Mailing Address - Fax:845-437-3181
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-431-5677
Practice Address - Fax:845-437-3181
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285824208000000X
CT722432080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics