Basic Information
Provider Information
NPI: 1508325747
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOUDHURY
FirstName: ASAD
MiddleName: UZZAMAN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 829641
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191829641
CountryCode: US
TelephoneNumber: 6723705296
FaxNumber: 2152303725
Practice Location
Address1: 599 W STATE ST
Address2:  
City: DOYLESTOWN
State: PA
PostalCode: 189012567
CountryCode: US
TelephoneNumber: 2153452885
FaxNumber: 2153452552
Other Information
ProviderEnumerationDate: 03/18/2019
LastUpdateDate: 09/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XMD477676PAY Allopathic & Osteopathic PhysiciansHospitalist 
207R00000XMD477676PAN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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