Basic Information
Provider Information
NPI: 1003002841
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOUDHARY
FirstName: SAHER
MiddleName: KARIM
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 INDEPENDENCE PT STE 212
Address2:  
City: GREENVILLE
State: SC
PostalCode: 296154536
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 200 PATEWOOD DR STE B350
Address2:  
City: GREENVILLE
State: SC
PostalCode: 29615
CountryCode: US
TelephoneNumber: 8644544500
FaxNumber: 8644544505
Other Information
ProviderEnumerationDate: 09/14/2007
LastUpdateDate: 07/09/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400X39333SCY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

ID Information
IDTypeStateIssuerDescription
39333705SC MEDICAID


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