Healthcare Provider Details

I. General information

NPI: 1710960893
Provider Name (Legal Business Name): SUMITA PAUL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUMITA P CHOWDHURY MD, MPH

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date: 10/11/2017
Reactivation Date: 05/10/2021

III. Provider practice location address

710 S CENTRAL AVE STE 210
GLENDALE CA
91204-4645
US

IV. Provider business mailing address

710 S CENTRAL AVE STE 210
GLENDALE CA
91204-4645
US

V. Phone/Fax

Practice location:
  • Phone: 818-247-0160
  • Fax: 818-247-4628
Mailing address:
  • Phone: 818-247-0160
  • Fax: 818-247-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.47223
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC183090
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME133478
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: