Provider Demographics
NPI:1912904236
Name:CHAUDHARY, RIAZ N (MD)
Entity Type:Individual
Prefix:DR
First Name:RIAZ
Middle Name:N
Last Name:CHAUDHARY
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 1:3841 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3435
Mailing Address - Country:US
Mailing Address - Phone:419-691-8132
Mailing Address - Fax:419-691-2061
Practice Address - Street 1:3841 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3435
Practice Address - Country:US
Practice Address - Phone:419-691-8132
Practice Address - Fax:419-691-2061
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35100084207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH308787Medicaid
OHD89546Medicare UPIN
OHCH0422773Medicare ID - Type UnspecifiedMEDICARE