Healthcare Provider Details

I. General information

NPI: 1912106170
Provider Name (Legal Business Name): ABHA CHOUDHARY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABHA CHOUDHARY M.D.

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BOULEVARD
DALLAS TX
75390-7208
US

IV. Provider business mailing address

P.O. BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3903
  • Fax: 214-648-2481
Mailing address:
  • Phone: 214-648-3903
  • Fax: 214-648-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08460100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberQ2118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: