Provider Demographics
NPI:1770686248
Name:KHANDAKER, DILARA (MD)
Entity Type:Individual
Prefix:DR
First Name:DILARA
Middle Name:
Last Name:KHANDAKER
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 1:346 MCCAGG RD
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-5808
Mailing Address - Country:US
Mailing Address - Phone:518-669-2621
Mailing Address - Fax:
Practice Address - Street 1:346 MCCAGG RD
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-5808
Practice Address - Country:US
Practice Address - Phone:518-669-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144914208M00000X
NY192931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036144914Medicaid
IL036144914Medicaid
F62818Medicare UPIN