Provider Demographics
NPI:1063852275
Name:CHAUDHRY MEDICAL GROUP, PC.
Entity Type:Organization
Organization Name:CHAUDHRY MEDICAL GROUP, PC.
Other - Org Name:EXPRESS CARE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AYESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-288-1700
Mailing Address - Street 1:1650 DIXWELL AVE
Mailing Address - Street 2:A
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3147
Mailing Address - Country:US
Mailing Address - Phone:203-288-1700
Mailing Address - Fax:203-859-5392
Practice Address - Street 1:1650 DIXWELL AVE
Practice Address - Street 2:A
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-3147
Practice Address - Country:US
Practice Address - Phone:203-288-1700
Practice Address - Fax:203-859-5392
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAUDHRY MEDICAL GROUP, PC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-02
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========OtherTAX ID