Healthcare Provider Details

I. General information

NPI: 1710861638
Provider Name (Legal Business Name): KOMIL CHOUDHRY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 ALTAMONT PLACE
WHITE PLAINS MD
20695-3052
US

IV. Provider business mailing address

24035 THREE NOTCH RD SUITE 300
HOLLYWOOD MD
20636-4871
US

V. Phone/Fax

Practice location:
  • Phone: 240-518-6021
  • Fax: 240-518-6021
Mailing address:
  • Phone: 301-373-7900
  • Fax: 301-373-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR245407
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR245407
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: