Provider Demographics
NPI:1609832245
Name:RAHAMAN, SULTAN HAMID (MD,)
Entity Type:Individual
Prefix:
First Name:SULTAN
Middle Name:HAMID
Last Name:RAHAMAN
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 1:225 N RONALD REAGAN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4158
Mailing Address - Country:US
Mailing Address - Phone:407-767-8006
Mailing Address - Fax:
Practice Address - Street 1:225 N RONALD REAGAN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4158
Practice Address - Country:US
Practice Address - Phone:407-767-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370876400Medicaid
FL370876400Medicaid
FL05701ZMedicare ID - Type Unspecified