Provider Demographics
NPI:1114910361
Name:CHAUDHRY, KHALID MAHMOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:MAHMOOD
Last Name:CHAUDHRY
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 1:1556 GLENEAGLES DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-5225
Mailing Address - Country:US
Mailing Address - Phone:419-494-9325
Mailing Address - Fax:
Practice Address - Street 1:1556 GLENEAGLES DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-5225
Practice Address - Country:US
Practice Address - Phone:419-494-9325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 376J00000X
OH350678272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155960Medicaid
OHMA4244922Medicare PIN