Provider Demographics
NPI:1407858228
Name:CHOUDHARY, SANJAY KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:KUMAR
Last Name:CHOUDHARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:7215 OLD OAK BLVD
Practice Address - Street 2:SUITE A420
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3340
Practice Address - Country:US
Practice Address - Phone:440-816-5816
Practice Address - Fax:440-243-4819
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH82588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2402788Medicaid
OH2402788Medicaid
OH4111162Medicare PIN
OHCH4111161Medicare ID - Type Unspecified