Healthcare Provider Details

I. General information

NPI: 1083031330
Provider Name (Legal Business Name): RITTIK CHAUDHURI M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 SMITH AVE STE 220
BALTIMORE MD
21209-3607
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-735-6400
  • Fax: 410-955-0141
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD85342
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: