Provider Demographics
NPI:1053358531
Name:CHOSLOVSKY, SYDNEY C (MD)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:C
Last Name:CHOSLOVSKY
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 1:65 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6207
Mailing Address - Country:US
Mailing Address - Phone:408-279-1400
Mailing Address - Fax:408-279-3216
Practice Address - Street 1:65 N 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6207
Practice Address - Country:US
Practice Address - Phone:408-279-1400
Practice Address - Fax:408-279-3216
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28868207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0016700Medicaid
CAYYY49719YMedicare PIN
CAA43890Medicare UPIN