Provider Demographics
NPI:1942266960
Name:CHOUDHURY, ANJU (MD)
Entity Type:Individual
Prefix:
First Name:ANJU
Middle Name:
Last Name:CHOUDHURY
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 1:1393 CELANESE RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1722
Mailing Address - Country:US
Mailing Address - Phone:803-329-3103
Mailing Address - Fax:803-325-2232
Practice Address - Street 1:1393 CELANESE RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1722
Practice Address - Country:US
Practice Address - Phone:803-329-3103
Practice Address - Fax:803-325-2232
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790633WMedicaid
SC175330Medicaid
SC175330Medicaid
SCG480048492Medicare ID - Type Unspecified