Provider Demographics
NPI:1821092743
Name:CHAUDHURI, PRABIR K (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABIR
Middle Name:K
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 1:4510 DORR ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4040
Mailing Address - Country:US
Mailing Address - Phone:419-383-4025
Mailing Address - Fax:419-383-6235
Practice Address - Street 1:1325 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8009
Practice Address - Country:US
Practice Address - Phone:419-383-6644
Practice Address - Fax:419-383-2924
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053332208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618746Medicaid
OHCH0581875Medicare ID - Type Unspecified
OH0618746Medicaid