MEDICARE: SUSANTI K CHOWDHURY M.D.

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	174400000X	Specialist	ME0065187	FL

General Provider Information

NPI Number	:	1497756498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANTI K CHOWDHURY M.D.

Provider Business Mailing 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	:	727-584-4764

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	:	727-584-4764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	09/21/2011

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