Provider Demographics
NPI:1992749436
Name:CHOUDHRY, SAJID M (MD)
Entity type:Individual
Prefix:DR
First Name:SAJID
Middle Name:M
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 1:307 ELMGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4249
Mailing Address - Country:US
Mailing Address - Phone:401-301-7145
Mailing Address - Fax:
Practice Address - Street 1:530 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5762
Practice Address - Country:US
Practice Address - Phone:401-276-4020
Practice Address - Fax:508-838-2200
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1611602084P0800X
RI91932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G33043Medicare UPIN
MAA36414Medicare ID - Type Unspecified