Provider Demographics
NPI:1316597446
Name:CENTER FOR KIDNEY DISEASE
Entity Type:Organization
Organization Name:CENTER FOR KIDNEY DISEASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAIKH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-788-7119
Mailing Address - Street 1:12 MOONSTONE CT
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3097
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 MOONSTONE CT
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3097
Practice Address - Country:US
Practice Address - Phone:406-788-7119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30206444Medicaid
I44529OtherMEDICARE UPIN