Healthcare Provider Details

I. General information

NPI: 1619103637
Provider Name (Legal Business Name): VISHAL CHAUDHARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 SQUALICUM PKWY
BELLINGHAM WA
98225-1851
US

IV. Provider business mailing address

542 LONDON COURT II
EGG HARBOR TOWNSHIP NJ
08234-5012
US

V. Phone/Fax

Practice location:
  • Phone: 360-788-6841
  • Fax: 360-756-6847
Mailing address:
  • Phone: 609-829-5053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60094977
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: