Provider Demographics
NPI:1801024559
Name:CHAUHAN, CHETANKUMAR KESHAVBHAI (MD)
Entity type:Individual
Prefix:
First Name:CHETANKUMAR
Middle Name:KESHAVBHAI
Last Name:CHAUHAN
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 1:23 MAIDA RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2531
Mailing Address - Country:US
Mailing Address - Phone:908-388-1716
Mailing Address - Fax:
Practice Address - Street 1:1503 SAINT GEORGES AVE STE 106
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3427
Practice Address - Country:US
Practice Address - Phone:908-388-1716
Practice Address - Fax:856-212-1214
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09202000208M00000X
CT50259208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0326470Medicaid