Healthcare Provider Details

I. General information

NPI: 1932196938
Provider Name (Legal Business Name): GHULAM MUQTADA CHAUDHRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD. LAHEY CLINIC, INC.
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

41 MALL RD. LAHEY CLINIC, INC.
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8863
  • Fax: 781-744-5577
Mailing address:
  • Phone: 781-744-8863
  • Fax: 781-744-5577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number14865
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number77836
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number77836
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: