Provider Demographics
NPI:1629187752
Name:HASAN, CHOUDHURY S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHOUDHURY
Middle Name:S
Last Name:HASAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9712 63RD DR
Mailing Address - Street 2:SUITE-CA
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2243
Mailing Address - Country:US
Mailing Address - Phone:718-830-3388
Mailing Address - Fax:718-732-1667
Practice Address - Street 1:9712 63RD DR
Practice Address - Street 2:SUITE-CA
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2243
Practice Address - Country:US
Practice Address - Phone:718-830-3388
Practice Address - Fax:718-732-1667
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY187727207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2012784OtherAETNA
NY01324794Medicaid
NY2012784OtherAETNA