Provider Demographics
NPI:1770518722
Name:CHUDGAR, SIREN RASIK (MD)
Entity type:Individual
Prefix:DR
First Name:SIREN
Middle Name:RASIK
Last Name:CHUDGAR
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 1:976 BALLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6428
Mailing Address - Country:US
Mailing Address - Phone:518-393-0391
Mailing Address - Fax:518-372-3281
Practice Address - Street 1:976 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6428
Practice Address - Country:US
Practice Address - Phone:518-393-0391
Practice Address - Fax:518-372-3281
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY74562OtherGHI/HMO
NY02458639Medicaid
NY10070848OtherCDPHP
NY72V691OtherEMPIRE BC
NY363060OtherMVP
NY7814611OtherAETNA
NY000403932001OtherBSNENY
NY363060OtherMVP
NYH82340Medicare UPIN