Provider Demographics
NPI:1245263318
Name:CHOCKALINGAM, MIRABAI (MD)
Entity type:Individual
Prefix:DR
First Name:MIRABAI
Middle Name:
Last Name:CHOCKALINGAM
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 1:2828 BAIRD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1247
Mailing Address - Country:US
Mailing Address - Phone:585-586-2355
Mailing Address - Fax:585-586-2922
Practice Address - Street 1:2828 BAIRD RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1247
Practice Address - Country:US
Practice Address - Phone:585-586-2355
Practice Address - Fax:585-586-2922
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01943613Medicaid
NY01943613Medicaid
NYG93537Medicare UPIN