Provider Demographics
NPI:1306037585
Name:CHAUDHARI, SWETANSHU (MD)
Entity Type:Individual
Prefix:DR
First Name:SWETANSHU
Middle Name:
Last Name:CHAUDHARI
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 1:10970 SHADOW CREEK PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0101
Mailing Address - Country:US
Mailing Address - Phone:832-398-0112
Mailing Address - Fax:832-201-0344
Practice Address - Street 1:10970 SHADOW CREEK PKWY
Practice Address - Street 2:STE 110
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-0101
Practice Address - Country:US
Practice Address - Phone:832-398-0112
Practice Address - Fax:832-201-0344
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5616207P00000X, 207Q00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4666961977OtherMYUTMB 4666961977
TXTXB104765Medicare PIN