Provider Demographics
NPI:1497727879
Name:CHAUDHURI, SURAJIT (MD)
Entity Type:Individual
Prefix:DR
First Name:SURAJIT
Middle Name:
Last Name:CHAUDHURI
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:PO BOX 42907
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-2907
Mailing Address - Country:US
Mailing Address - Phone:910-483-8361
Mailing Address - Fax:910-485-0672
Practice Address - Street 1:1205 CAPE CT
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4404
Practice Address - Country:US
Practice Address - Phone:910-483-8361
Practice Address - Fax:910-483-8361
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400218207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8922136Medicaid
NC0207MOtherBCBS OF NORTH CAROLINA
NC0207MOtherBCBS OF NORTH CAROLINA
2199331Medicare ID - Type Unspecified