Provider Demographics
NPI:1477788172
Name:CHAUDHURY, BISWASHREE (MD)
Entity Type:Individual
Prefix:
First Name:BISWASHREE
Middle Name:
Last Name:CHAUDHURY
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 1:1845 SATELLITE BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5256
Mailing Address - Country:US
Mailing Address - Phone:404-778-5220
Mailing Address - Fax:404-778-6451
Practice Address - Street 1:1845 SATELLITE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5256
Practice Address - Country:US
Practice Address - Phone:404-778-5220
Practice Address - Fax:404-778-6451
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2013-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067401207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
27567P001Medicare UPIN