Healthcare Provider Details

I. General information

NPI: 1083278824
Provider Name (Legal Business Name): CHAUDHRY SAAD SOHAIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 BURWICK AVE APT # 2603
ORANGE PARK FL
32073
US

IV. Provider business mailing address

2121 BURWICK AVE APT # 2603
ORANGE PARK FL
32073
US

V. Phone/Fax

Practice location:
  • Phone: 347-248-8134
  • Fax: 847-679-1126
Mailing address:
  • Phone: 347-248-8134
  • Fax: 847-679-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30381
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: