Provider Demographics
NPI:1023481629
Name:CHATOOR, MATTHEW SCOTT RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT RUSSELL
Last Name:CHATOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:506 LENOX AVE
Mailing Address - Street 2:MLK 11.101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1802
Mailing Address - Country:US
Mailing Address - Phone:212-939-1000
Mailing Address - Fax:212-939-3536
Practice Address - Street 1:506 LENOX AVE
Practice Address - Street 2:MLK 11.101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-1000
Practice Address - Fax:212-939-3536
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD200453208600000X, 2086S0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program