Provider Demographics
NPI:1952468118
Name:CHAUDRY, SUSAN LANE (NP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LANE
Last Name:CHAUDRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11029 SNOWSHOE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3248
Mailing Address - Country:US
Mailing Address - Phone:301-468-2213
Mailing Address - Fax:
Practice Address - Street 1:1630 EUCLID ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5675
Practice Address - Country:US
Practice Address - Phone:202-884-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN29353363LP0200X, 367A00000X
MDRO52404363LP0200X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife