Healthcare Provider Details

I. General information

NPI: 1437447844
Provider Name (Legal Business Name): PRIYANK CHAUDHARY M.D., MBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11009 INGLESIDE PL STE 303
RALEIGH NC
27614-6697
US

IV. Provider business mailing address

11009 INGLESIDE PL STE 303
RALEIGH NC
27614-6697
US

V. Phone/Fax

Practice location:
  • Phone: 919-341-3603
  • Fax: 919-341-3610
Mailing address:
  • Phone: 919-341-3603
  • Fax: 919-341-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2016-00501
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: