Provider Demographics
NPI:1083642078
Name:CHINTAKAYALA, DURGA (MD)
Entity Type:Individual
Prefix:DR
First Name:DURGA
Middle Name:
Last Name:CHINTAKAYALA
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 1:57-42 244 ST
Mailing Address - Street 2:APR 2-8
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1907
Mailing Address - Country:US
Mailing Address - Phone:718-483-2934
Mailing Address - Fax:
Practice Address - Street 1:86 EAST 49 STREET
Practice Address - Street 2:SUITE D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-604-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1007Q1Medicare ID - Type Unspecified