Provider Demographics
NPI:1164615886
Name:CHAUDHRY, MUNA FAISAL (MD)
Entity Type:Individual
Prefix:MRS
First Name:MUNA
Middle Name:FAISAL
Last Name:CHAUDHRY
Suffix:
Gender:F
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:PO BOX 1020
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-1020
Mailing Address - Country:US
Mailing Address - Phone:276-963-1150
Mailing Address - Fax:276-963-1110
Practice Address - Street 1:1957 2ND ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2303
Practice Address - Country:US
Practice Address - Phone:276-963-1150
Practice Address - Fax:276-963-1110
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC12091OtherMEDICARE INDIVIDUAL PTAN
VA020035100OtherBLACK LUNG
VACO8032OtherMEDICARE GROUP PTAN
VA282424OtherANTHEM BLUE CROSS BLUE SHIELD
VA020035101OtherBLACK LUNG