MEDICARE: ABDUL W CHAUDHRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	0101053259	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	243439	OTHER	VA	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	541371648	OTHER	VA	TAX ID

General Provider Information

NPI Number	:	1396742037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDUL W CHAUDHRY M.D.

Provider Business Mailing Address
First Line	:	4560 SOUTH BLVD
Second Line	:	SUITE 202
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1160
Country	:	US
Telephone Number	:	757-623-0005
Fax Number	:	757-548-1129

Provider Business Practice Location Address
First Line	:	814 KEMPSVILLE RD
Second Line	:	SUITE 102 BLDG 17
City	:	NORFOLK
State	:	VA
Zip	:	23502-4001
Country	:	US
Telephone Number	:	757-623-0005
Fax Number	:	757-389-5412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/22/2019

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