Provider Demographics
NPI:1104864719
Name:CHOWDHURY, PRADEEPTA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRADEEPTA
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 1:670 PONAHAWAI ST
Mailing Address - Street 2:STE116
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2660
Mailing Address - Country:US
Mailing Address - Phone:808-961-3404
Mailing Address - Fax:808-961-5460
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:STE116
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-961-3404
Practice Address - Fax:808-961-5460
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00212102Medicaid
HI00A0213015OtherHMSA
HI00212102Medicaid
HIH101833Medicare PIN