Provider Demographics
NPI:1154687531
Name:CHAUDHARY, MIRNAL ANIL (MD)
Entity Type:Individual
Prefix:
First Name:MIRNAL
Middle Name:ANIL
Last Name:CHAUDHARY
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 1:22 S GREENE ST # S10B00
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-5840
Mailing Address - Fax:410-328-0717
Practice Address - Street 1:310 STOCK ST STE 3
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2276
Practice Address - Country:US
Practice Address - Phone:717-637-1738
Practice Address - Fax:717-646-7430
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00952042086S0129X
PAFC18548602086S0129X
390200000X
PAMD4788692086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program