1164615886 NPI number — MRS. MUNA FAISAL CHAUDHRY M.D.

Table of content: MRS. MUNA FAISAL CHAUDHRY M.D. (NPI 1164615886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164615886 NPI number — MRS. MUNA FAISAL CHAUDHRY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAUDHRY
Provider First Name:
MUNA
Provider Middle Name:
FAISAL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1164615886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONAKER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24260-1020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-963-1150
Provider Business Mailing Address Fax Number:
276-963-1110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1957 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLANDS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24641-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-963-1150
Provider Business Practice Location Address Fax Number:
276-963-1110
Provider Enumeration Date:
08/27/2007

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: 207Q00000X , with the licence number:  0101244743 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MC12091 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 020035100 . This is a "BLACK LUNG" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: CO8032 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 282424 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 020035101 . This is a "BLACK LUNG" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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