Provider Demographics
NPI:1760527790
Name:M. AZHAR CHAUDHRY M.D. INC.
Entity Type:Organization
Organization Name:M. AZHAR CHAUDHRY M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:AZHAR
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-420-9227
Mailing Address - Street 1:228 INDEPENDENCE
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9435
Mailing Address - Country:US
Mailing Address - Phone:570-420-9227
Mailing Address - Fax:570-420-9244
Practice Address - Street 1:228 INDEPENDENCE ROAD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9435
Practice Address - Country:US
Practice Address - Phone:570-420-9244
Practice Address - Fax:570-420-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017440E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000139970OtherMED PLUS
PA7356405OtherAETNA
PA0016576140003Medicaid
PACHI1457706OtherBLUE CROSS
PA2593208OtherGHI
PAC30895Medicare UPIN
PA068330Medicare ID - Type Unspecified