Provider Demographics
NPI:1821158163
Name:KUCHEROV, MISHA N (MD)
Entity Type:Individual
Prefix:DR
First Name:MISHA
Middle Name:N
Last Name:KUCHEROV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:NICHOLAS
Other - Last Name:KUCHEROV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:243 NORTH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1154
Mailing Address - Country:US
Mailing Address - Phone:845-454-0728
Mailing Address - Fax:845-452-5807
Practice Address - Street 1:243 NORTH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1154
Practice Address - Country:US
Practice Address - Phone:845-454-0728
Practice Address - Fax:845-452-5807
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161410207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01160094Medicaid
NY01160094Medicaid
NYA68031Medicare UPIN