Provider Demographics
NPI:1245400936
Name:JITHENDRA P CHOUDARY MD LLC
Entity Type:Organization
Organization Name:JITHENDRA P CHOUDARY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JITHENDRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHOUDARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-863-5362
Mailing Address - Street 1:1380 NW WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-6310
Mailing Address - Country:US
Mailing Address - Phone:513-863-5362
Mailing Address - Fax:513-863-6772
Practice Address - Street 1:1380 NW WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6310
Practice Address - Country:US
Practice Address - Phone:513-863-5362
Practice Address - Fax:513-863-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074059207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2262279Medicaid
OH2262279Medicaid