Provider Demographics
NPI:1629379565
Name:CHOWDHURY, REZWAN HOSSAIN (MD)
Entity Type:Individual
Prefix:
First Name:REZWAN
Middle Name:HOSSAIN
Last Name:CHOWDHURY
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 1:14155 N 83RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5639
Mailing Address - Country:US
Mailing Address - Phone:623-773-2873
Mailing Address - Fax:234-144-9226
Practice Address - Street 1:7695 S RESEARCH DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1812
Practice Address - Country:US
Practice Address - Phone:480-256-1664
Practice Address - Fax:480-726-1854
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ428802085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDE8713OtherRAILROAD MEDICARE
AZ578682Medicaid
AZ4663668OtherCIGNA
AZQMX000000087947OtherMERCY CARE
AZ9650586OtherAETNA
AZZ179691Medicare PIN
AZ4663668OtherCIGNA