Basic Information
| Provider Information | |||||||||
| NPI: | 1093730012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOWDHURY | ||||||||
| FirstName: | MUZIBUL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 SILAS DEANE HWY FL 1 | ||||||||
| Address2: | |||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061094337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609726970 | ||||||||
| FaxNumber: | 8609727040 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 DAY HILL RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060955720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606962450 | ||||||||
| FaxNumber: | 8606962460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 12/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/10/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 016876 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | 016876 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2V2685 | 01 | CT | HEALTHNET | OTHER | 001168764 | 05 | CT | MEDICAID | HAS690 | 01 | CT | OXFORD | OTHER | 0083796 | 01 | CT | AETNA/US HEALTHCARE | OTHER | 010016876CT04 | 01 | CT | ANTHEM | OTHER | 712992 | 01 | CT | CONNECTICARE | OTHER |