Healthcare Provider Details

I. General information

NPI: 1467749374
Provider Name (Legal Business Name): CHITRA CHOUDHARY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 S GOVERNORS AVE SUITE 101
DOVER DE
19904-6920
US

IV. Provider business mailing address

640 S STATE ST POB 3RD FLOOR
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-401-1500
  • Fax: 302-672-6450
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-257-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number57.023982
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC1-0011632
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: