Healthcare Provider Details

I. General information

NPI: 1457447849
Provider Name (Legal Business Name): PRADIPTA CHAUDHURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 LA CANADA ST STE 140
LAS VEGAS NV
89169-2579
US

IV. Provider business mailing address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

V. Phone/Fax

Practice location:
  • Phone: 702-216-3346
  • Fax: 702-671-6883
Mailing address:
  • Phone: 702-216-3346
  • Fax: 702-671-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20761
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.067034
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number17733
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: