Provider Demographics
NPI:1639285778
Name:RAHMAN, MOHAMMAD MISBAHUR (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MISBAHUR
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 1:602 SCHENECTADY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1821
Mailing Address - Country:US
Mailing Address - Phone:718-953-5700
Mailing Address - Fax:718-953-5702
Practice Address - Street 1:602 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1821
Practice Address - Country:US
Practice Address - Phone:718-953-5700
Practice Address - Fax:718-953-5702
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00191924Medicaid
840221Medicare ID - Type Unspecified
D47828Medicare UPIN