Provider Demographics
NPI:1770685521
Name:ACHARYA, SHASHIDAR B (MD)
Entity type:Individual
Prefix:DR
First Name:SHASHIDAR
Middle Name:B
Last Name:ACHARYA
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 1:1240 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2217
Mailing Address - Country:US
Mailing Address - Phone:714-771-2800
Mailing Address - Fax:714-771-3200
Practice Address - Street 1:1240 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2217
Practice Address - Country:US
Practice Address - Phone:714-771-2800
Practice Address - Fax:714-771-3200
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-036182207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A361820Medicaid
CA00A361820OtherBLUE SHIELD
CAA-28000Medicare UPIN
CA00A361820OtherBLUE SHIELD