Provider Demographics
NPI:1528018579
Name:CHOWDHURY, SHAHIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHIDA
Middle Name:
Last Name:CHOWDHURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 HUNTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-4679
Mailing Address - Country:US
Mailing Address - Phone:313-903-7740
Mailing Address - Fax:
Practice Address - Street 1:1602 SKIPWITH RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-5298
Practice Address - Country:US
Practice Address - Phone:804-289-4985
Practice Address - Fax:202-854-7825
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012415192080N0001X
DCMD036589208000000X
MI4301075832208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4610492Medicaid
MI4610492Medicaid
DC133930YT2Medicare PIN