Provider Demographics
NPI:1760486617
Name:CHOWDHURY, SHABBIR A (MD)
Entity Type:Individual
Prefix:
First Name:SHABBIR
Middle Name:A
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 1:548 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4426
Mailing Address - Country:US
Mailing Address - Phone:910-484-3400
Mailing Address - Fax:910-484-3404
Practice Address - Street 1:548 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4426
Practice Address - Country:US
Practice Address - Phone:910-484-3400
Practice Address - Fax:910-484-3404
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004011852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138C3Medicaid
NC2034726Medicare ID - Type UnspecifiedPROVIDER NUMBER
NCH24988Medicare UPIN