Provider Demographics
NPI:1013088228
Name:CHAUDHRY, SANJAY (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:CHAUDHRY
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 1:92 N 4TH ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1691
Mailing Address - Country:US
Mailing Address - Phone:740-633-4447
Mailing Address - Fax:740-633-4250
Practice Address - Street 1:92 N 4TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1691
Practice Address - Country:US
Practice Address - Phone:740-633-4447
Practice Address - Fax:740-633-4250
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062737C174400000X
WV18071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0956069Medicaid
WV0077693000Medicaid
F90449Medicare UPIN
OH0755696Medicare ID - Type Unspecified
OH0956069Medicaid