MEDICARE: SUSANTI K. CHOWDHURY MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1225302417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSANTI K. CHOWDHURY MD PA

Provider Business Mailing Address
First Line	:	2980 N BEVERLY GLEN CIR
Second Line	:	SUITE 301
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1726
Country	:	US
Telephone Number	:	310-474-9809
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 E BAY DR
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-2217
Country	:	US
Telephone Number	:	727-526-2771
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUSANTI K. CHOWDHURY
Credential	:	MD
Telephone Number	:	727-526-2771

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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