Healthcare Provider Details

I. General information

NPI: 1780756544
Provider Name (Legal Business Name): FIAZ CHOUDHRI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 LARK DRIVE WHITNEY M. YOUNG JR. HEALTH CENTER
ALBANY NY
12207
US

IV. Provider business mailing address

920 LARK DRIVE WHITNEY M. YOUNG JR. HEALTH CENTER
ALBANY NY
12207
US

V. Phone/Fax

Practice location:
  • Phone: 518-465-4771
  • Fax: 518-242-4770
Mailing address:
  • Phone: 518-465-4771
  • Fax: 518-242-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number108669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: