Provider Demographics
NPI:1093872871
Name:CHOUDHRY, UMESH (MD)
Entity Type:Individual
Prefix:DR
First Name:UMESH
Middle Name:
Last Name:CHOUDHRY
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 1:3001 EXECUTIVE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5323
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:727-541-6558
Practice Address - Street 1:920 S MYRTLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3918
Practice Address - Country:US
Practice Address - Phone:727-462-0444
Practice Address - Fax:727-462-0446
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68190207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27355OtherBLUE CROSS BLUE SHIELD
FL27355OtherBLUE CROSS BLUE SHIELD
FLK7622Medicare ID - Type UnspecifiedGROUP#
FLG05227Medicare UPIN
FL27355BMedicare ID - Type UnspecifiedINDIVIDUAL #