Provider Demographics
NPI:1790732998
Name:CHAUDHRI, IMRAN I (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:I
Last Name:CHAUDHRI
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 1:620 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4804
Mailing Address - Country:US
Mailing Address - Phone:814-889-2866
Mailing Address - Fax:814-889-6785
Practice Address - Street 1:620 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4804
Practice Address - Country:US
Practice Address - Phone:814-889-2866
Practice Address - Fax:814-889-6785
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59502207P00000X
PAMD050134L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5521106Medicaid
NJ5521106Medicaid
NJ746719Medicare ID - Type Unspecified