Healthcare Provider Details

I. General information

NPI: 1255544748
Provider Name (Legal Business Name): DR. NAHLA CHAUDHARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NAHLA CHOUDHARY DDS

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 SUSHRUTA DR
MARTINSBURG WV
25401-8876
US

IV. Provider business mailing address

1007 SUSHRUTA DR
MARTINSBURG WV
25401-8876
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0991
  • Fax: 304-274-9546
Mailing address:
  • Phone: 304-263-0991
  • Fax: 304-274-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number50 054322
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3881
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14553
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: