Provider Demographics
NPI:1992015812
Name:ASHOK ROYCHOUDHURY, M.D., P.A.
Entity Type:Organization
Organization Name:ASHOK ROYCHOUDHURY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYCHOUDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-724-0300
Mailing Address - Street 1:2032A SOUTHSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1944
Mailing Address - Country:US
Mailing Address - Phone:904-724-0300
Mailing Address - Fax:904-720-1943
Practice Address - Street 1:2032A SOUTHSIDE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1944
Practice Address - Country:US
Practice Address - Phone:904-724-0300
Practice Address - Fax:904-720-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033384208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037707400Medicaid
FL15476Medicare PIN