Provider Demographics
NPI:1871880740
Name:CHOUDHRY, MOHAMMAD MUSTAFA (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:MUSTAFA
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 1:8990 MORGANS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8990 MORGANS RIDGE DR
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:MD
Practice Address - Zip Code:21875-2083
Practice Address - Country:US
Practice Address - Phone:908-230-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DEC1-0011059207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1871880740Medicaid