1487060323 NPI number — AFZAL CHOUDHRY, MD, P.A

Table of content: (NPI 1487060323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487060323 NPI number — AFZAL CHOUDHRY, MD, P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFZAL CHOUDHRY, MD, P.A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487060323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26218 US HIGHWAY 27
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34748-1707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-323-1758
Provider Business Mailing Address Fax Number:
352-323-1894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26218 US HIGHWAY 27
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34748-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-323-1758
Provider Business Practice Location Address Fax Number:
352-323-1894
Provider Enumeration Date:
07/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BLAKEMORE
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BILLING MGR
Authorized Official Telephone Number:
352-323-1758

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME86954 , 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: 267916700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016811700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com