Provider Demographics
NPI:1063504033
Name:RAHMAN, MOHAMMAD MAHMUDUR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:MAHMUDUR
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 1:18310 DALNY RD
Mailing Address - Street 2:JAMAICA ESTATES
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2465
Mailing Address - Country:US
Mailing Address - Phone:718-864-8882
Mailing Address - Fax:718-383-8047
Practice Address - Street 1:17012 HIGHLAND AVE
Practice Address - Street 2:UNIT 101
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2782
Practice Address - Country:US
Practice Address - Phone:718-864-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211211207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01902643Medicaid
NYBR6043703OtherDEA
NYG83394Medicare UPIN