Provider Demographics
NPI:1336115039
Name:CHAUDHRY, SHAZIA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAZIA
Middle Name:R
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 1:6499 S MASON MONTGOMERY RD STE C
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1773
Mailing Address - Country:US
Mailing Address - Phone:513-760-5511
Mailing Address - Fax:513-781-9600
Practice Address - Street 1:6499 S MASON MONTGOMERY RD STE C
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1773
Practice Address - Country:US
Practice Address - Phone:513-760-5511
Practice Address - Fax:513-781-9600
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114165207P00000X
IL036114165207R00000X
MO2006015214207R00000X
OH35 085685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207499401Medicaid
IL036114165OtherBLUE SHIELD
IL036114165Medicaid
MO1003831678Medicare PIN
IL036114165OtherBLUE SHIELD
ILK22962Medicare PIN