Basic Information
| Provider Information | |||||||||
| NPI: | 1932195823 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAUDHRY | ||||||||
| FirstName: | TANVEER | ||||||||
| MiddleName: | AHMAD | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 17222 HOSPITAL BLVD STE 116 | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346018925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526785550 | ||||||||
| FaxNumber: | 3526785551 | ||||||||
| Practice Location | |||||||||
| Address1: | 17222 HOSPITAL BLVD | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346018925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526785550 | ||||||||
| FaxNumber: | 3526785551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME85148 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | ME85148 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 2084P0800X | ME85148 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 266168300 | 05 | FL | MEDICAID | 62852 | 01 | FL | BCBS | OTHER | 62852X | 01 | FL | MEDICARE | OTHER | BC7338014 | 01 | FL | DEA | OTHER | P00807407 | 01 | FL | MEDICARE RAILROAD | OTHER |