Healthcare Provider Details

I. General information

NPI: 1790192128
Provider Name (Legal Business Name): ZAIN CHAUDHRY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 SAINT THOMAS DR
PHILADELPHIA PA
19116-3855
US

IV. Provider business mailing address

10625 SAINT THOMAS DR
PHILADELPHIA PA
19116-3855
US

V. Phone/Fax

Practice location:
  • Phone: 215-520-1791
  • Fax:
Mailing address:
  • Phone: 215-520-1791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC006595
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: