Healthcare Provider Details

I. General information

NPI: 1487975223
Provider Name (Legal Business Name): DIVAY CHAUDHRY M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 08/30/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ROTH CHURCH RD
SPRING GROVE PA
17362-1406
US

IV. Provider business mailing address

22 ROTH CHURCH RD
SPRING GROVE PA
17362-1406
US

V. Phone/Fax

Practice location:
  • Phone: 717-757-3400
  • Fax:
Mailing address:
  • Phone: 717-757-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0078110
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD458549
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: