Provider Demographics
NPI:1962665679
Name:CHAVARRIA, NELSON F (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:F
Last Name:CHAVARRIA
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 1:2 BENNETT AVE MEZZ FL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2148
Mailing Address - Country:US
Mailing Address - Phone:917-388-3214
Mailing Address - Fax:917-732-7744
Practice Address - Street 1:2 BENNETT AVENUE
Practice Address - Street 2:MEZZANINE FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2148
Practice Address - Country:US
Practice Address - Phone:917-388-3214
Practice Address - Fax:917-732-7744
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261432207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY261432OtherLICENSE
NY04527419Medicaid