Provider Demographics
NPI:1548242720
Name:CHAUDHURY, TRIPTESH K (MD)
Entity Type:Individual
Prefix:DR
First Name:TRIPTESH
Middle Name:K
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:P O BOX 1823
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627
Mailing Address - Country:US
Mailing Address - Phone:409-293-4242
Mailing Address - Fax:409-853-1108
Practice Address - Street 1:10700 MCPHERSON RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6268
Practice Address - Country:US
Practice Address - Phone:956-523-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH18722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084300501Medicaid
TX131794309Medicaid
TX084300501Medicaid
TX00N76AMedicare ID - Type UnspecifiedAMERICAN MEDICAL