Basic Information
Provider Information | |||||||||
NPI: | 1447335401 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHOUDHURY | ||||||||
FirstName: | RAJIB | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3600 LIND AVE SW | ||||||||
Address2: | SUITE 100 ATTN CREDENTIALING | ||||||||
City: | RENTON | ||||||||
State: | WA | ||||||||
PostalCode: | 980574970 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4256902715 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4011 TALBOT ROAD SOUTH | ||||||||
Address2: | SUITE 500 | ||||||||
City: | RENTON | ||||||||
State: | WA | ||||||||
PostalCode: | 98055 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4256903482 | ||||||||
FaxNumber: | 4256909082 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/26/2006 | ||||||||
LastUpdateDate: | 08/18/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/18/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | MD00042188 | WA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207UN0901X | MD00042188 | WA | N |   | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | MD00042188 | WA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | 1010691 | 05 | WA |   | MEDICAID | 3908CH | 01 | WA | REGENCE | OTHER | 8350530 | 05 | WA |   | MEDICAID | 8932882 | 01 | WA | CRIME VICTIMS | OTHER | P00006652 | 01 | WA | RR MEDICARE | OTHER | 0169915 | 01 | WA | L&I | OTHER |