Provider Demographics
NPI:1538148283
Name:CHOUDARI, CHINTAMANENI P (MD)
Entity type:Individual
Prefix:DR
First Name:CHINTAMANENI
Middle Name:P
Last Name:CHOUDARI
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 1:11110 MEDICAL CAMPUS RD STE 242
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6728
Mailing Address - Country:US
Mailing Address - Phone:240-513-7072
Mailing Address - Fax:240-513-6241
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 242
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6728
Practice Address - Country:US
Practice Address - Phone:240-513-7072
Practice Address - Fax:240-513-6241
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076586207RG0100X
IN01047211A207RG0100X
MDD0066559207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1673071OtherAETNA - HMO
MD611061-04OtherCAREFIRST
MD874550OtherMEDICARE
290280OtherJHHC
4319500OtherAETNA HMO
MD9366546OtherCIGNA
MDP00460055OtherRAILROAD MEDICARE
6213953OtherAETNA
MDE6310004OtherCAREFIRST BLUE CHOICE
4319500OtherAETNA HMO
MD611061-04OtherCAREFIRST
6213953OtherAETNA