Provider Demographics
NPI:1376520502
Name:DIVGI, CHAITANYA R (MD)
Entity Type:Individual
Prefix:
First Name:CHAITANYA
Middle Name:R
Last Name:DIVGI
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 1:722 W 168TH ST
Mailing Address - Street 2:R-114
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3727
Mailing Address - Country:US
Mailing Address - Phone:212-305-5521
Mailing Address - Fax:212-304-5277
Practice Address - Street 1:722 W 168TH ST
Practice Address - Street 2:R-114
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3727
Practice Address - Country:US
Practice Address - Phone:212-305-5521
Practice Address - Fax:212-304-5277
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY185493207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94690Medicare UPIN
NY82F631Medicare ID - Type Unspecified