Provider Demographics
NPI:1871531889
Name:CHOUDHURY, RUHUL AHMED (MD)
Entity type:Individual
Prefix:
First Name:RUHUL
Middle Name:AHMED
Last Name:CHOUDHURY
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 1:292 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2132
Mailing Address - Country:US
Mailing Address - Phone:423-784-3600
Mailing Address - Fax:423-784-4602
Practice Address - Street 1:3080 N HIGHWAY 25 W
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-8602
Practice Address - Country:US
Practice Address - Phone:606-549-9107
Practice Address - Fax:606-549-9862
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34311207R00000X
TN30920207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64353113Medicaid
TN3116107OtherBCBST
TNKY0109OtherJOHN DEERE
TN4102759OtherBCBS OF TN
TNP00234830OtherRAILROAD MEDICARE
TN3832392Medicaid
TN100021020Medicaid
110179309OtherMEDICARE RAILROAD
TN3116107Medicaid
TN3832392Medicaid
TN100021020Medicaid
110179309OtherMEDICARE RAILROAD