Provider Demographics
NPI:1386741007
Name:CHOWDHURY, QUAMRUL HASAN (MD)
Entity type:Individual
Prefix:
First Name:QUAMRUL
Middle Name:HASAN
Last Name:CHOWDHURY
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 1:1054 STARDUST LN
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548
Mailing Address - Country:US
Mailing Address - Phone:917-547-4425
Mailing Address - Fax:
Practice Address - Street 1:5707 N 22ND ST
Practice Address - Street 2:MENTAL HEALTH CARE INC
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-272-2878
Practice Address - Fax:813-272-3766
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME921312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41030OtherBCBS OF FL
FL274790100Medicaid
FL274790100Medicaid
FL41030OtherBCBS OF FL