1194836676 NPI number — DR. SHEHZAD HAFIZ CHOUDRY MD

Table of content: NERISSA PAGUIRIGAN CRISTOBAL (NPI 1134405129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194836676 NPI number — DR. SHEHZAD HAFIZ CHOUDRY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOUDRY
Provider First Name:
SHEHZAD
Provider Middle Name:
HAFIZ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1194836676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 W COPELAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-841-1570
Provider Business Mailing Address Fax Number:
321-841-1569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 W COPELAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-841-1570
Provider Business Practice Location Address Fax Number:
321-841-1569
Provider Enumeration Date:
08/31/2006

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: 2084N0400X , with the licence number:  200501013 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 2005-01013 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P2900X , with the licence number: ME141780 , 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: 141C2 . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: E4062 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5901299 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00298080 . This is a "RAILROAD-MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 806154 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 103694500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8913923 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 103694500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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