Provider Demographics
NPI:1053344804
Name:CHANGKAKOTI, NARENDRA C (MD)
Entity type:Individual
Prefix:DR
First Name:NARENDRA
Middle Name:C
Last Name:CHANGKAKOTI
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 1:1404 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3016
Mailing Address - Country:US
Mailing Address - Phone:585-467-4700
Mailing Address - Fax:
Practice Address - Street 1:1404 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3016
Practice Address - Country:US
Practice Address - Phone:585-467-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMDC921OtherPREFERRED CARE
NY5217468OtherAETNA
NY100697BJOtherPREFERRED CARE
NY000913329002OtherHEALTHNOW
NYBB3667Medicare ID - Type Unspecified
NY100697BJOtherPREFERRED CARE
NYB72137Medicare UPIN