Healthcare Provider Details

I. General information

NPI: 1104827088
Provider Name (Legal Business Name): SUDHENDU CHOUBEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MAIN ST
RADFORD VA
24141-1721
US

IV. Provider business mailing address

2602FRANKLIN RD
ROANOKE VA
24014-1010
US

V. Phone/Fax

Practice location:
  • Phone: 540-283-7252
  • Fax: 540-639-0664
Mailing address:
  • Phone: 540-343-8565
  • Fax: 540-344-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101058790
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101-058790
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: