Provider Demographics
NPI:1639123292
Name:CHOUDHURY, SAMBHU N (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMBHU
Middle Name:N
Last Name:CHOUDHURY
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 1:4700 E GALBRAITH RD # 300A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2754
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-686-4217
Practice Address - Street 1:4700 E GALBRAITH RD # 300A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2754
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-686-4217
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074051207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64961840OtherKENTUCKY MEDICAID NUMBER
OH2086013Medicaid
KY64961840OtherKENTUCKY MEDICAID NUMBER
OH2086013Medicaid