1144757915 NPI number — IMRAN H CHOWDHURY MD PA

Table of content: (NPI 1144757915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144757915 NPI number — IMRAN H CHOWDHURY MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMRAN H CHOWDHURY MD PA
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:
INFECTIOUS DISEASE INFUSION CENTER
Provider Other Organization Name Type Code:
3
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:
1144757915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6510 KENILWORTH AVE
Provider Second Line Business Mailing Address:
SUITE 2500
Provider Business Mailing Address City Name:
RIVERDALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20737-1339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-997-7677
Provider Business Mailing Address Fax Number:
410-997-1636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6510 KENILWORTH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 2500
Provider Business Practice Location Address City Name:
RIVERDALE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20737-9997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-770-6345
Provider Business Practice Location Address Fax Number:
240-467-3993
Provider Enumeration Date:
05/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CHOWDHURY
Authorized Official First Name:
IMRAN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-997-7677

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 409510300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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