Basic Information
| Provider Information | |||||||||
| NPI: | 1184691065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAUDHRI | ||||||||
| FirstName: | KAMRAN | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ATWELL RD | ||||||||
| Address2: | |||||||||
| City: | COOPERSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133261301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075473456 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 ATWELL RD | ||||||||
| Address2: | |||||||||
| City: | COOPERSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133261301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075473456 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 10/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 222888 | MA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 219404 | NY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 409550 | 01 | TUFTS HEALTH PLAN | OTHER | 4346949 | 01 | CIGNA HEALTH PLAN | OTHER | 2085101 | 05 | MA | MEDICAID | 7535289 | 01 | AETNA US HEALTHCARE | OTHER | 784008 | 01 | MVP HEALTH CARE | OTHER | 0801399 | 01 | EVERCARE | OTHER | 76103 | 01 | HEALTHY START | OTHER | J28225 | 01 | BLUE CARE ELECT | OTHER | J28225 | 01 | BLUE SHIELD INDEMNITY | OTHER | 042472266 | 01 | HEALTHCARE VALUE | OTHER | 90589 | 01 | FALLON COMMUNITY HEALTH | OTHER | AA19861 | 01 | HARVARD PILGRIM | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 76103 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | J28225 | 01 | BLUE SHIELD HMO BLUE | OTHER |