Basic Information
| Provider Information | |||||||||
| NPI: | 1114943164 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PIEDMONT PODIATRY ASSOCIATES P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 MILLS AVE | ||||||||
| Address2: | C/O SUBODH CHOUDHARY | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642323668 | ||||||||
| FaxNumber: | 8642710526 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 MILLS AVE | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642323668 | ||||||||
| FaxNumber: | 8642710526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 09/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHOUDHARY | ||||||||
| AuthorizedOfficialFirstName: | SUDOBH | ||||||||
| AuthorizedOfficialMiddleName: | KUMAR | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8642323668 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | GP9955 | 05 | SC | MEDICAID | AA32286626 | 01 | SC | MEDICARE PTAN | OTHER |