Provider Demographics
NPI:1548605686
Name:CHAUDHURY, LEENA (MD)
Entity Type:Individual
Prefix:
First Name:LEENA
Middle Name:
Last Name:CHAUDHURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E ORANGEBURG AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3399
Mailing Address - Country:US
Mailing Address - Phone:209-622-0877
Mailing Address - Fax:
Practice Address - Street 1:2222 E ORANGEBURG AVE STE A2
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3399
Practice Address - Country:US
Practice Address - Phone:209-622-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134288208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice