Provider Demographics
NPI:1619229549
Name:MUZIBUL CHOWDHURY, MD, PC
Entity Type:Organization
Organization Name:MUZIBUL CHOWDHURY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUZIBUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-688-6920
Mailing Address - Street 1:1080 DAY HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-4742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1080 DAY HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-4742
Practice Address - Country:US
Practice Address - Phone:860-688-6920
Practice Address - Fax:860-298-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016876207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001168764Medicaid
CT060000085Medicare Oscar/Certification
CTA61889Medicare UPIN