Provider Demographics
NPI:1710960893
Name:PAUL, SUMITA (MD)
Entity type:Individual
Prefix:DR
First Name:SUMITA
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUMITA
Other - Middle Name:P
Other - Last Name:CHOWDHURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:710 S CENTRAL AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4645
Mailing Address - Country:US
Mailing Address - Phone:818-247-0160
Mailing Address - Fax:818-247-4628
Practice Address - Street 1:710 S CENTRAL AVE STE 210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4645
Practice Address - Country:US
Practice Address - Phone:818-247-0160
Practice Address - Fax:818-247-4628
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2024-12-06
Deactivation Date:2017-10-11
Deactivation Code:
Reactivation Date:2021-05-10
Provider Licenses
StateLicense IDTaxonomies
CAC183090207RC0000X
ALMD.47223207R00000X
FLME133478207RC0000X
FL133478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE
TX8F21171OtherMEDICARE PTAN
TXH33901Medicare UPIN