Provider Demographics
NPI:1043473424
Name:RAHAMAN, BRAD A (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:A
Last Name:RAHAMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BEACH 116TH ST APT 6C
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2447
Mailing Address - Country:US
Mailing Address - Phone:202-746-8130
Mailing Address - Fax:
Practice Address - Street 1:41 E KINGS HWY FL 1
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1216
Practice Address - Country:US
Practice Address - Phone:888-982-8594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262043207P00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFR2693643OtherDEA