=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316234776
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAURAV CHAUDHARY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2011
-----------------------------------------------------
Last Update Date | 06/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 MEDICAL CENTER DR
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-9466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-487-7991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 MEDICAL CENTER DR
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-9466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-487-7991
-----------------------------------------------------
Fax | 606-439-6685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 01076171A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 01076171A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------