Provider Demographics
NPI:1750381943
Name:CHIANG, KONAN (MD)
Entity type:Individual
Prefix:
First Name:KONAN
Middle Name:
Last Name:CHIANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BRISTOL DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-5206
Mailing Address - Country:US
Mailing Address - Phone:845-695-1291
Mailing Address - Fax:845-342-6463
Practice Address - Street 1:225 DOLSON AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6569
Practice Address - Country:US
Practice Address - Phone:845-342-6464
Practice Address - Fax:845-342-6463
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194135207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01651798Medicaid
NY01651798Medicaid
NY808681Medicare PIN
NY808681Medicare ID - Type Unspecified