Provider Demographics
NPI:1407049539
Name:CHAUDHRY, FAHD A (MD)
Entity Type:Individual
Prefix:
First Name:FAHD
Middle Name:A
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 1:7557B DANNAHER DR STE 225
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3568
Mailing Address - Country:US
Mailing Address - Phone:865-647-5800
Mailing Address - Fax:865-647-5979
Practice Address - Street 1:7557B DANNAHER DR STE 225
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3568
Practice Address - Country:US
Practice Address - Phone:865-647-5800
Practice Address - Fax:865-647-5979
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD450468207R00000X
TNMD53673207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021384Medicaid
PAMD450468OtherSTATE MEDICAL LICENCE NUMBER
PA597586OtherTPI GROUP MEDICARE PTAN
AZ37450OtherSTATE MEDICAL LICENCE
PACD4829OtherTPI RAILROAD MEDICARE GROUP