Provider Demographics
NPI:1750341418
Name:CHAUDHARY, KHALID MAHMOOD (MD)
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:MAHMOOD
Last Name:CHAUDHARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHALID
Other - Middle Name:M
Other - Last Name:CHAUDHARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1217 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-3203
Mailing Address - Country:US
Mailing Address - Phone:281-342-8761
Mailing Address - Fax:281-232-7492
Practice Address - Street 1:1217 1ST ST
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-3203
Practice Address - Country:US
Practice Address - Phone:281-342-8761
Practice Address - Fax:281-232-7492
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI099687801Medicaid
45D0495711OtherCLIA
AC6729391OtherDEA
45D0495711OtherCLIA
TXTPI099687801Medicaid