Provider Demographics
NPI:1720348451
Name:GOLAM S CHOUDHURY, MD LTD
Entity Type:Organization
Organization Name:GOLAM S CHOUDHURY, MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOLAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHOUDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-731-5113
Mailing Address - Street 1:PO BOX 96475
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-6475
Mailing Address - Country:US
Mailing Address - Phone:702-731-5113
Mailing Address - Fax:702-734-8381
Practice Address - Street 1:3121 S MARYLAND PKWY
Practice Address - Street 2:SUITE 414
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2307
Practice Address - Country:US
Practice Address - Phone:702-731-5113
Practice Address - Fax:702-734-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3742208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty