Provider Demographics
NPI:1508133539
Name:DAS, PRATAP CHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:PRATAP
Middle Name:CHANDRA
Last Name:DAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 WYCKOFF AVENUE
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-2927
Mailing Address - Country:US
Mailing Address - Phone:718-821-6285
Mailing Address - Fax:347-295-3675
Practice Address - Street 1:95 WYCKOFF AVENUE
Practice Address - Street 2:SUITE 1001
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-2927
Practice Address - Country:US
Practice Address - Phone:718-821-6285
Practice Address - Fax:347-295-3675
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY280433207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY180221000189OtherFIDELIS
NY04231274Medicaid