Provider Demographics
NPI:1073678835
Name:TRIVEDI, KALYANI R (MD)
Entity Type:Individual
Prefix:DR
First Name:KALYANI
Middle Name:R
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD
Mailing Address - Street 2:FL 2
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:600 IVY ST STE 208
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1627
Practice Address - Country:US
Practice Address - Phone:607-735-5790
Practice Address - Fax:607-735-5788
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2020-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH351279462080P0202X
CAA807942080P0202X
NY2245252080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05503237Medicaid
PA103629680Medicaid