Provider Demographics
NPI:1447251889
Name:SINGH, CHANDERDEEP (MD)
Entity type:Individual
Prefix:
First Name:CHANDERDEEP
Middle Name:
Last Name:SINGH
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 1:2209 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5999
Mailing Address - Country:US
Mailing Address - Phone:315-801-8350
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:2209 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5999
Practice Address - Country:US
Practice Address - Phone:315-801-8567
Practice Address - Fax:315-801-8568
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225034-1208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02285069Medicaid
NYP00174003OtherRR MEDICARE
NY02285069Medicaid
NYJ400005819Medicare PIN