Provider Demographics
NPI:1962715987
Name:CHOUDHRY, MUHAMMAD W (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:W
Last Name:CHOUDHRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N CALIFORNIA ST
Mailing Address - Street 2:STE 14A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2333 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5530
Practice Address - Country:US
Practice Address - Phone:209-942-1005
Practice Address - Fax:209-942-0455
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4379207RC0000X, 207RI0011X
CAA166359207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201147820Medicaid
INP01317960Medicare PIN
IN264430106Medicare PIN
IN201147820Medicaid