Provider Demographics
NPI:1093730012
Name:CHOWDHURY, MUZIBUL (MD)
Entity Type:Individual
Prefix:
First Name:MUZIBUL
Middle Name:
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 1:1290 SILAS DEANE HWY FL 1
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-6970
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:1060 DAY HILL RD STE 203
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-5720
Practice Address - Country:US
Practice Address - Phone:860-696-2450
Practice Address - Fax:860-696-2460
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016876207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V2685OtherHEALTHNET
CT001168764Medicaid
CTHAS690OtherOXFORD
CT0083796OtherAETNA/US HEALTHCARE
CT010016876CT04OtherANTHEM
CT712992OtherCONNECTICARE
CT712992OtherCONNECTICARE
CT001168764Medicaid