Provider Demographics
NPI:1487060323
Name:AFZAL CHOUDHRY, MD, P.A
Entity type:Organization
Organization Name:AFZAL CHOUDHRY, MD, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAKEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-323-1758
Mailing Address - Street 1:26218 US HIGHWAY 27
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-1707
Mailing Address - Country:US
Mailing Address - Phone:352-323-1758
Mailing Address - Fax:352-323-1894
Practice Address - Street 1:26218 US HIGHWAY 27
Practice Address - Street 2:SUITE 105
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-1707
Practice Address - Country:US
Practice Address - Phone:352-323-1758
Practice Address - Fax:352-323-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267916700Medicaid
FL267916700Medicaid