Provider Demographics
NPI:1114098902
Name:TALATI, KIRAN (MD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:TALATI
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 1:20-24 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1710
Mailing Address - Country:US
Mailing Address - Phone:607-772-6161
Mailing Address - Fax:607-772-6138
Practice Address - Street 1:20-24 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1710
Practice Address - Country:US
Practice Address - Phone:607-772-6161
Practice Address - Fax:607-772-6138
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01766912Medicaid
NY11690XMedicare ID - Type Unspecified
NY01766912Medicaid