Basic Information
| Provider Information | |||||||||
| NPI: | 1104864966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOWDHURY | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | RAYHAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 681 SCRANTON CARBONDALE HWY | ||||||||
| Address2: | |||||||||
| City: | EYNON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184031022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708765900 | ||||||||
| FaxNumber: | 5708765300 | ||||||||
| Practice Location | |||||||||
| Address1: | 681 SCRANTON CARBONDALE HWY | ||||||||
| Address2: | |||||||||
| City: | EYNON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184031022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708765900 | ||||||||
| FaxNumber: | 5708765300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD-042212-L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0017661860001 | 05 | PA | MEDICAID |