Provider Demographics
NPI:1639289382
Name:CHAUDHARY, AYAZ J (MD)
Entity Type:Individual
Prefix:DR
First Name:AYAZ
Middle Name:J
Last Name:CHAUDHARY
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 1:367 S. GULPH RD
Mailing Address - Street 2:ATT: IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:803-226-0073
Mailing Address - Fax:
Practice Address - Street 1:48 PHYSICIAN DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6388
Practice Address - Country:US
Practice Address - Phone:803-226-0073
Practice Address - Fax:803-226-0074
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044896207RG0100X
ND9715207RG0100X
SC26590207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000898433FMedicaid
SCG44896Medicaid
GA000898433FMedicaid
SCG44896Medicaid
H44491Medicare UPIN