Provider Demographics
NPI:1104804475
Name:CHAUDHRY, PERVAIZ AKHTAR (MD)
Entity type:Individual
Prefix:MR
First Name:PERVAIZ
Middle Name:AKHTAR
Last Name:CHAUDHRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30 E RIVER PARK PL W
Mailing Address - Street 2:#260
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1545
Mailing Address - Country:US
Mailing Address - Phone:559-441-1777
Mailing Address - Fax:559-441-0726
Practice Address - Street 1:30 E RIVER PARK PL W
Practice Address - Street 2:#260
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1545
Practice Address - Country:US
Practice Address - Phone:559-441-1774
Practice Address - Fax:559-441-0726
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA796622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA79662AMedicare ID - Type Unspecified
I09890Medicare UPIN