Provider Demographics
NPI:1104827088
Name:CHOUBEY, SUDHENDU (MD)
Entity type:Individual
Prefix:
First Name:SUDHENDU
Middle Name:
Last Name:CHOUBEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1010
Mailing Address - Country:US
Mailing Address - Phone:540-343-8565
Mailing Address - Fax:540-344-9627
Practice Address - Street 1:401 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1721
Practice Address - Country:US
Practice Address - Phone:540-283-7252
Practice Address - Fax:540-639-0664
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058790207RC0000X
VA0101-058790207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACF9878OtherRR MEDICARE GROUP
VA5822360Medicaid
VA6072771Medicaid
VA010248515Medicaid
VA010104556Medicaid
VA6072771Medicaid
VA009834S57Medicare PIN
VA060000917Medicare ID - Type Unspecified
VA010248515Medicaid
VA010104556Medicaid
VAF60121Medicare UPIN