=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841288685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | UMBREEN J CHAUDHARY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2005
-----------------------------------------------------
Last Update Date | 04/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 N FAYETTEVILLE ST STE 301
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27203-4671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-633-4034
-----------------------------------------------------
Fax | 866-467-6816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 N FAYETTEVILLE ST SUITE 300
-----------------------------------------------------
City | ASHEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27203-4670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-633-4020
-----------------------------------------------------
Fax | 336-633-4069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 200400470
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 200400470
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------