=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104827088
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUDHENDU CHOUBEY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 04/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 E MAIN ST
-----------------------------------------------------
City | RADFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24141-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-283-7252
-----------------------------------------------------
Fax | 540-639-0664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2602FRANKLIN RD
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24014-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-343-8565
-----------------------------------------------------
Fax | 540-344-9627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 0101058790
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 0101-058790
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------