Healthcare Provider Details

I. General information

NPI: 1447830260
Provider Name (Legal Business Name): HANNA GEORGIA CHOUDHRY ERIKSSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BARTON WAY
MOUNT LAUREL NJ
08054-5240
US

IV. Provider business mailing address

30 BARTON WAY
MOUNT LAUREL NJ
08054-5240
US

V. Phone/Fax

Practice location:
  • Phone: 201-669-8078
  • Fax:
Mailing address:
  • Phone: 201-669-8078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB12345800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: