Provider Demographics
NPI:1609832096
Name:KANDATH, DAVID D (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:KANDATH
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 1:6 CARE LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8624
Mailing Address - Country:US
Mailing Address - Phone:800-243-5854
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:6 CARE LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8624
Practice Address - Country:US
Practice Address - Phone:518-587-7625
Practice Address - Fax:518-587-0273
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162533174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0121919406204Medicaid
NY060014715OtherRR MEDICARE
NY060014715OtherRR MEDICARE
NY0121919406204Medicaid