Provider Demographics
NPI:1972504504
Name:CHODIRKER, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CHODIRKER
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 1:173 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5521
Mailing Address - Country:US
Mailing Address - Phone:781-235-7900
Mailing Address - Fax:781-237-9930
Practice Address - Street 1:173 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5521
Practice Address - Country:US
Practice Address - Phone:781-235-7900
Practice Address - Fax:781-237-9930
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
043196618OtherGREAT WEST
4199853OtherAETNA/US HEALTHCARE
0103579OtherCIGNA
043196618OtherINTEGRATED HEALTH PLANS
043196618OtherUNITED HEALTHCARE
34586OtherFALLON COMMUNITY HP
J11610OtherBCBS-MA
043196618OtherCOMMONWEALTH INDEMNITY
MA3084884Medicaid
043196618OtherHCVM
0452115OtherAETNA/US HEALTHCARE HMO
074617OtherTUFTS
71194OtherHPHC
043196618OtherPHCS
043196618OtherUNITED HEALTHCARE
34586OtherFALLON COMMUNITY HP
J11610Medicare PIN