Provider Demographics
NPI:1104864966
Name:CHOWDHURY, MOHAMMED RAYHAN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:RAYHAN
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 1:681 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1022
Mailing Address - Country:US
Mailing Address - Phone:570-876-5900
Mailing Address - Fax:570-876-5300
Practice Address - Street 1:681 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403-1022
Practice Address - Country:US
Practice Address - Phone:570-876-5900
Practice Address - Fax:570-876-5300
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-042212-L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017661860001Medicaid
PA0017661860001Medicaid
PA806211Medicare PIN