Provider Demographics
NPI:1740289867
Name:CHAUDHURI, PAKHI (MD)
Entity type:Individual
Prefix:
First Name:PAKHI
Middle Name:
Last Name:CHAUDHURI
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 1:1199 MAIN AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5259
Mailing Address - Country:US
Mailing Address - Phone:970-259-7337
Mailing Address - Fax:970-259-7366
Practice Address - Street 1:1199 MAIN AVE
Practice Address - Street 2:STE 205
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5259
Practice Address - Country:US
Practice Address - Phone:970-259-7337
Practice Address - Fax:970-259-7366
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO42100208000000X
WAMD00036886208000000X
NMMD20030711208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63779030Medicaid