Provider Demographics
NPI:1205047255
Name:CHOUDHURY, SUMAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUMAN
Middle Name:
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 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:3700 W NOLANA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4884
Practice Address - Country:US
Practice Address - Phone:956-213-2700
Practice Address - Fax:956-213-0812
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084736207P00000X, 207RN0300X
NY236617207Q00000X, 207RN0300X
TXP5348207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2488213Medicaid
OH2488213Medicaid
NYG40002115Medicare PIN
NYA400030150Medicare PIN
OH4274391Medicare PIN