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General NPI Number Information
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NPI Number | 1164598512
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Entity Type | Individual
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Provider Name | BABAR MURTAZA CHOUDHRY MD/OWNER
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 420 S JACKSON ST
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City | POTTSVILLE
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State | PA
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Zip | 17901-3625
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Country | US
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Telephone | 570-621-5500
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Fax | 570-621-5077
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Provider Business Mailing Address
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Address Line | PO BOX 1388
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City | KINGSTON
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State | PA
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Zip | 18704-0379
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Country | US
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Telephone | 570-288-8881
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Fax | 570-288-8065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD066893L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | MD066893L
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License Number State | PA
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