Basic Information
| Provider Information | |||||||||
| NPI: | 1922028208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER ORLANDO HOSPITALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 478 E ALTAMONTE DR # 108 # 410 | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075456232 | ||||||||
| FaxNumber: | 4077670750 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 FLORIDA CENTRAL PKWY | ||||||||
| Address2: | |||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327507651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077670727 | ||||||||
| FaxNumber: | 4077670750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHAUDHRY | ||||||||
| AuthorizedOfficialFirstName: | AZHAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4075456232 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME82888 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | DB8326 | 01 | FL | RAILROAD MEDICARE | OTHER | 269296100 | 05 | FL | MEDICAID | 74520 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 74520 | 01 | FL | MEDICARE | OTHER |