Provider Demographics
NPI:1932196938
Name:CHAUDHRY, GHULAM MUQTADA (MD)
Entity Type:Individual
Prefix:
First Name:GHULAM
Middle Name:MUQTADA
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 1:41 MALL RD.
Mailing Address - Street 2:LAHEY CLINIC, INC.
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8863
Mailing Address - Fax:781-744-5577
Practice Address - Street 1:41 MALL RD.
Practice Address - Street 2:LAHEY CLINIC, INC.
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8863
Practice Address - Fax:781-744-5577
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14865207RC0001X
MA77836207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110002212AMedicaid
MA0126071Medicaid
NH30205461Medicaid
MA110002212AMedicaid
MAA2214703Medicare PIN
NHA2214707Medicare PIN
MAA2214704Medicare PIN
NH30205461Medicaid