Basic Information
Provider Information
NPI: 1275702920
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOWDHURY
FirstName: PARVIN
MiddleName: AKTER
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9400 TURKEY LAKE RD
Address2: MP 452
City: ORLANDO
State: FL
PostalCode: 328198001
CountryCode: US
TelephoneNumber: 3218435500
FaxNumber: 3218435550
Practice Location
Address1: 9400 TURKEY LAKE RD
Address2: MP 452
City: ORLANDO
State: FL
PostalCode: 328198001
CountryCode: US
TelephoneNumber: 3218435500
FaxNumber: 3218435550
Other Information
ProviderEnumerationDate: 02/27/2008
LastUpdateDate: 11/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XME98113FLY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
ME9811301FLMEDICAL LICENSEOTHER
00119240005FL MEDICAID


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