Provider Demographics
NPI:1093792459
Name:CHAUDHRY, MOHAMMAD AZHAR (MD, FCCP)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:AZHAR
Last Name:CHAUDHRY
Suffix:
Gender:M
Credentials:MD, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:POCONO HEALTHCARE MANAGEMENT-PROFESSIONAL CENTER
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-426-2733
Mailing Address - Fax:570-426-2643
Practice Address - Street 1:600 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6214
Practice Address - Country:US
Practice Address - Phone:570-420-9227
Practice Address - Fax:570-420-9244
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017440E174400000X, 207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPPO7356405OtherAETNA
PA000657614 0005Medicaid
PA50091558OtherCAPITAL BLUE CROSS
PA816334OtherFIRST PRIORITY
PA000000139970OtherMED PLUS
PAHMO3222446OtherAETNA
PACHI1457706OtherBC/BS
PA124443OtherHIGHMARK BLUE SHIELD
PAP00023022OtherRR MC
PA0016576140003Medicaid
PAP00023022OtherRR MC
PA124443PZPMedicare PIN
PA124443OtherHIGHMARK BLUE SHIELD
PAC30895Medicare UPIN