Provider Demographics
NPI:1467426999
Name:CHIVATE, VANDANA (MD)
Entity Type:Individual
Prefix:DR
First Name:VANDANA
Middle Name:
Last Name:CHIVATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221801-1207L00000X
PAMD417856207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050085020OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PA0018724650001Medicaid
PAGU616349OtherMEDICARE GROUP
NYP00323959OtherRR MEDICARE PIN
NY02188172Medicaid
H54057Medicare UPIN
PACC9269OtherRR MEDICARE GROUP
NYDD2005Medicare ID - Type Unspecified