Provider Demographics
NPI:1235211475
Name:CHOUDHRY, WAJID M (MD)
Entity Type:Individual
Prefix:
First Name:WAJID
Middle Name:M
Last Name:CHOUDHRY
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 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-0553
Mailing Address - Fax:585-922-0496
Practice Address - Street 1:1561 LONG POND RD
Practice Address - Street 2:SUITE 302
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4117
Practice Address - Country:US
Practice Address - Phone:585-723-1120
Practice Address - Fax:585-723-1776
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189406207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01480386Medicaid
NY01480386Medicaid
NY17555EMedicare ID - Type Unspecified