Provider Demographics
NPI:1053590448
Name:SUSANTI K CHOWDHURY MD PA
Entity type:Organization
Organization Name:SUSANTI K CHOWDHURY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSANTI
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-526-2771
Mailing Address - Street 1:1945 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2217
Mailing Address - Country:US
Mailing Address - Phone:727-526-2771
Mailing Address - Fax:727-584-4764
Practice Address - Street 1:1945 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2217
Practice Address - Country:US
Practice Address - Phone:727-526-2771
Practice Address - Fax:727-584-4764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065187174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6100Medicare PIN
FL4532320001Medicare NSC