Provider Demographics
NPI:1003806373
Name:BAGCHI, KAUSHIK (MD)
Entity Type:Individual
Prefix:
First Name:KAUSHIK
Middle Name:
Last Name:BAGCHI
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 1:1367 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1069
Mailing Address - Country:US
Mailing Address - Phone:518-489-2666
Mailing Address - Fax:518-489-2666
Practice Address - Street 1:1367 WASHINGTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1069
Practice Address - Country:US
Practice Address - Phone:518-489-2666
Practice Address - Fax:518-489-2666
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215567207X00000X
NY204628-2207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0172511Medicaid
NY02315846Medicaid
MA0172511Medicaid
NYRB7143Medicare PIN