Provider Demographics
NPI:1689979759
Name:PACHIKARA, ABIN SAMSON (MD)
Entity Type:Individual
Prefix:
First Name:ABIN
Middle Name:SAMSON
Last Name:PACHIKARA
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 1:123 GENESEE ST
Mailing Address - Street 2:DEPARTMENT OF MEDICINE, MUNGAR PAVILION, ROOM 253
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2323
Mailing Address - Country:US
Mailing Address - Phone:315-797-2314
Mailing Address - Fax:315-797-0850
Practice Address - Street 1:123 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2323
Practice Address - Country:US
Practice Address - Phone:315-797-2314
Practice Address - Fax:315-797-0850
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY263581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program