Provider Demographics
NPI:1356335194
Name:CHARY, KANDALA KRISHNA (MD)
Entity type:Individual
Prefix:
First Name:KANDALA
Middle Name:KRISHNA
Last Name:CHARY
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 1:45 SPINDRIFT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7889
Mailing Address - Country:US
Mailing Address - Phone:716-565-0355
Mailing Address - Fax:716-565-9401
Practice Address - Street 1:45 SPINDRIFT DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7889
Practice Address - Country:US
Practice Address - Phone:716-565-0355
Practice Address - Fax:716-565-9401
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119189207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00611532Medicaid
B71567Medicare UPIN
NYA26305Medicare ID - Type Unspecified