Provider Demographics
NPI:1710281159
Name:CHAUDHRY, RABIA QUDDUS (MD)
Entity Type:Individual
Prefix:
First Name:RABIA
Middle Name:QUDDUS
Last Name:CHAUDHRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RABIA
Other - Middle Name:BEGUM
Other - Last Name:QUDDUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 NE SPANISH RIVER BLVD STE 28A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4517
Mailing Address - Country:US
Mailing Address - Phone:561-855-1999
Mailing Address - Fax:
Practice Address - Street 1:500 NE SPANISH RIVER BLVD STE 28A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-855-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08926500207K00000X, 208000000X
FLME123352207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019792000Medicaid