Provider Demographics
NPI:1699741439
Name:CHOWDHRY, IMTIAZ H (MD)
Entity type:Individual
Prefix:
First Name:IMTIAZ
Middle Name:H
Last Name:CHOWDHRY
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 1:10792 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3646
Mailing Address - Country:US
Mailing Address - Phone:410-964-3611
Mailing Address - Fax:410-992-4669
Practice Address - Street 1:10792 HICKORY RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3646
Practice Address - Country:US
Practice Address - Phone:410-964-3611
Practice Address - Fax:410-992-4669
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD24118OtherMAMSI
MD02311400Medicaid
MD525085OtherAETNA
MD8876OtherFED BS
MD306870-01OtherBLUE SHIELD
MD306870-01OtherBLUE SHIELD
MD02311400Medicaid