Provider Demographics
NPI:1255510459
Name:MYDOCTOR LLC
Entity type:Organization
Organization Name:MYDOCTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:N
Authorized Official - Last Name:CHAURASIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-818-6300
Mailing Address - Street 1:10229 N 92ND ST
Mailing Address - Street 2:SUITE I-103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4562
Mailing Address - Country:US
Mailing Address - Phone:877-818-6300
Mailing Address - Fax:888-203-2153
Practice Address - Street 1:10229 N 92ND ST
Practice Address - Street 2:SUITE I-103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4562
Practice Address - Country:US
Practice Address - Phone:877-818-6300
Practice Address - Fax:888-203-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ119003Medicare PIN