Provider Demographics
NPI:1629153531
Name:RAHMAN, SHAFIQUR M (MD)
Entity Type:Individual
Prefix:
First Name:SHAFIQUR
Middle Name:M
Last Name:RAHMAN
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:PO BOX 25522
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11202-5522
Mailing Address - Country:US
Mailing Address - Phone:718-369-3503
Mailing Address - Fax:718-369-3579
Practice Address - Street 1:263 SEVENTH AVE
Practice Address - Street 2:SUITE 4D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-369-3503
Practice Address - Fax:718-369-3579
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174757207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01102083Medicaid
D92245Medicare UPIN
NY01102083Medicaid