Provider Demographics
NPI:1164502225
Name:AHSAN, CHOWDHURY (MD)
Entity Type:Individual
Prefix:
First Name:CHOWDHURY
Middle Name:
Last Name:AHSAN
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 1:700 E. SILVERADO RANCH BLVD.
Mailing Address - Street 2:STE.#170
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7518
Mailing Address - Country:US
Mailing Address - Phone:702-240-6482
Mailing Address - Fax:702-804-0957
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:STE.#320
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-240-6482
Practice Address - Fax:702-804-0957
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000A84917207RC0000X
NV12110207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00172294OtherRR MEDICARE
NV100512207Medicaid
NV104022Medicare PIN
CAWA84917AMedicare PIN
CAP00172294OtherRR MEDICARE