Provider Demographics
NPI:1205829991
Name:CHAUDHRY, FAISAL W (MD)
Entity Type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:W
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: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:276-873-6300
Mailing Address - Fax:
Practice Address - Street 1:5705 REDBUD HWY
Practice Address - Street 2:
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24260
Practice Address - Country:US
Practice Address - Phone:276-873-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA282424OtherANTHEM BLUE CROSS
VA007610718Medicaid
VA200351OtherBLACK LUNG
VA5188559OtherAETNA
VA1522856OtherUMWA
VA110147847OtherRAILROAD MEDICARE
VA5800811Medicaid
VA110006769Medicare ID - Type Unspecified
VA5800811Medicaid
VA007610718Medicaid