1467749374 NPI number — CHITRA CHOUDHARY MD

Table of content: RYAN MICHAEL DEGEN MD (NPI 1245654201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467749374 NPI number — CHITRA CHOUDHARY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOUDHARY
Provider First Name:
CHITRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467749374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 S STATE ST
Provider Second Line Business Mailing Address:
POB 3RD FLOOR
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19901-3530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-480-1688
Provider Business Mailing Address Fax Number:
302-257-5777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1058 S GOVERNORS AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19904-6920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-401-1500
Provider Business Practice Location Address Fax Number:
302-672-6450
Provider Enumeration Date:
06/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 57.023982 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: C1-0011632 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1467749374 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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