Provider Demographics
NPI:1215231824
Name:SAMIR G. CHAUDHARI, M.D., P.A.
Entity Type:Organization
Organization Name:SAMIR G. CHAUDHARI, M.D., P.A.
Other - Org Name:SAMIR G. CHAUDHARI, M.D.,P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHAUDHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-898-2924
Mailing Address - Street 1:2501 N ORANGE AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-898-2924
Mailing Address - Fax:407-894-5387
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-898-2924
Practice Address - Fax:407-894-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95874208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278513700Medicaid
FL278513700Medicaid