Provider Demographics
NPI:1114943164
Name:PIEDMONT PODIATRY ASSOCIATES P A
Entity Type:Organization
Organization Name:PIEDMONT PODIATRY ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDOBH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHOUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:864-232-3668
Mailing Address - Street 1:11 MILLS AVE
Mailing Address - Street 2:C/O SUBODH CHOUDHARY
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4015
Mailing Address - Country:US
Mailing Address - Phone:864-232-3668
Mailing Address - Fax:864-271-0526
Practice Address - Street 1:11 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4015
Practice Address - Country:US
Practice Address - Phone:864-232-3668
Practice Address - Fax:864-271-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9955Medicaid
SCAA32286626OtherMEDICARE PTAN
SC6626Medicare UPIN
SCGP9955Medicaid