Provider Demographics
NPI:1629154653
Name:CHAFFIN, MATTHEW G (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:CHAFFIN
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 1:1304 BUCKLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:315-478-3311
Mailing Address - Fax:315-426-0796
Practice Address - Street 1:1304 BUCKLEY ROAD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212
Practice Address - Country:US
Practice Address - Phone:315-478-3311
Practice Address - Fax:315-426-0796
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238054-01207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY796631OtherMVP
NY2699049Medicaid
NY5771741OtherAETNA
NY000928684001OtherHEALTHNOW
NY2032464OtherUNITED HEALTHCARE
NY060214000032OtherFIDELIS
NY2699049Medicaid
NY000928684001OtherHEALTHNOW
NYP00330421Medicare PIN
NY34576AMedicare PIN
NY060214000032OtherFIDELIS