Provider Demographics
NPI:1760831622
Name:RAYCHAUDHURI, SREEJATA (MD)
Entity Type:Individual
Prefix:
First Name:SREEJATA
Middle Name:
Last Name:RAYCHAUDHURI
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 1:200 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3783
Mailing Address - Country:US
Mailing Address - Phone:774-232-7273
Mailing Address - Fax:
Practice Address - Street 1:200 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3783
Practice Address - Country:US
Practice Address - Phone:774-232-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 210518390200000X
PAMD475445207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program