1194750695 NPI number — DR. UDAY R CHAUHAN MD PA

Table of content: DR. UDAY R CHAUHAN MD PA (NPI 1194750695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194750695 NPI number — DR. UDAY R CHAUHAN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAUHAN
Provider First Name:
UDAY
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAUHAN
Provider Other First Name:
KEVIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1194750695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHAUHAN MEDICAL CENTER
Provider Second Line Business Mailing Address:
2720 REBECCA LANE STE 101
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-456-5159
Provider Business Mailing Address Fax Number:
386-456-0139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHAUHAN MEDICAL CENTER
Provider Second Line Business Practice Location Address:
2720 REBECCA LANE STE 101
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-456-5159
Provider Business Practice Location Address Fax Number:
386-456-0139
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME73576 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E0561X . This is a "MEDICARE ID NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261505300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44760 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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