Provider Demographics
NPI:1033245238
Name:RAHMAN, MAQSOODUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MAQSOODUR
Middle Name:
Last Name:RAHMAN
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 1:602 SCHENECTADY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1821
Mailing Address - Country:US
Mailing Address - Phone:718-953-5700
Mailing Address - Fax:718-953-5702
Practice Address - Street 1:602 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1821
Practice Address - Country:US
Practice Address - Phone:718-953-5700
Practice Address - Fax:718-953-5702
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168774207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00991786Medicaid
NYA64705Medicare UPIN
NY00991786Medicaid