MEDICARE: DR. GOLAM S. CHOUDHURY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	3742	NV

General Provider Information

NPI Number	:	1467508713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GOLAM S. CHOUDHURY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 96475
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-6475
Country	:	US
Telephone Number	:	702-731-5113
Fax Number	:	702-734-8381

Provider Business Practice Location Address
First Line	:	3121 S MARYLAND PKWY
Second Line	:	SUITE 414
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2307
Country	:	US
Telephone Number	:	702-731-5113
Fax Number	:	702-734-8381

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	05/10/2012

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Directions to “ DR. GOLAM S. CHOUDHURY M.D.” Practice Location

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