1841305612 NPI number — PRADEEPTA CHOWDHURY, MD, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841305612 NPI number — PRADEEPTA CHOWDHURY, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRADEEPTA CHOWDHURY, MD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841305612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 PONAHAWAI ST
Provider Second Line Business Mailing Address:
STE 116
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720-7831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-961-3404
Provider Business Mailing Address Fax Number:
808-961-5460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 PONAHAWAI ST
Provider Second Line Business Practice Location Address:
STE 116
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720-7831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-961-3404
Provider Business Practice Location Address Fax Number:
808-961-5460
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHOWDHURY
Authorized Official First Name:
PRADEEPTA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-961-3404

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  10069 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00121202 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10069 . This is a "OTHER INSURANCES" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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