Provider Demographics
NPI:1972958528
Name:CHAUDHARY, HIRA B (DD)
Entity type:Individual
Prefix:
First Name:HIRA
Middle Name:B
Last Name:CHAUDHARY
Suffix:
Gender:F
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 HOPE DR STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5687
Mailing Address - Country:US
Mailing Address - Phone:260-234-5400
Mailing Address - Fax:260-234-5395
Practice Address - Street 1:7411 HOPE DR STE C
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5687
Practice Address - Country:US
Practice Address - Phone:260-234-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70570207R00000X
IN02006600A207RG0300X, 207R00000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1972958528Medicaid