Provider Demographics
NPI:1700874740
Name:CHAUDHRY, IFTIKHAR M (MD)
Entity Type:Individual
Prefix:
First Name:IFTIKHAR
Middle Name:M
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 1:3046 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2815
Mailing Address - Country:US
Mailing Address - Phone:215-639-4500
Mailing Address - Fax:215-604-0355
Practice Address - Street 1:3046 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2815
Practice Address - Country:US
Practice Address - Phone:215-639-4500
Practice Address - Fax:215-604-0355
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056677L207W00000X
NJ25MA06125800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007520684Medicaid
NJ8081301Medicaid
NJ014950ZC98Medicare PIN
NJ8081301Medicaid
PA021705ZAJZMedicare PIN