Provider Demographics
NPI:1780756544
Name:CHOUDHRI, FIAZ (MD)
Entity type:Individual
Prefix:
First Name:FIAZ
Middle Name:
Last Name:CHOUDHRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 LARK DRIVE
Mailing Address - Street 2:WHITNEY M. YOUNG JR. HEALTH CENTER
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207
Mailing Address - Country:US
Mailing Address - Phone:518-465-4771
Mailing Address - Fax:518-242-4770
Practice Address - Street 1:920 LARK DRIVE
Practice Address - Street 2:WHITNEY M. YOUNG JR. HEALTH CENTER
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207
Practice Address - Country:US
Practice Address - Phone:518-465-4771
Practice Address - Fax:518-242-4770
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108669207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY108669OtherLICENSE
NYBC6497071OtherDEA