Provider Demographics
NPI:1790917003
Name:IQBAL A. CHOUDHRY, MD, INC.
Entity Type:Organization
Organization Name:IQBAL A. CHOUDHRY, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IQBAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHOUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-492-7827
Mailing Address - Street 1:4848 HIGBEE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2528
Mailing Address - Country:US
Mailing Address - Phone:330-492-7827
Mailing Address - Fax:330-492-7577
Practice Address - Street 1:4848 HIGBEE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2528
Practice Address - Country:US
Practice Address - Phone:330-492-7827
Practice Address - Fax:330-492-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350372882080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty