Provider Demographics
NPI:1922091685
Name:RAHMAN, QAMRUNNISA (MD)
Entity Type:Individual
Prefix:
First Name:QAMRUNNISA
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 UNION RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1470
Mailing Address - Country:US
Mailing Address - Phone:716-706-2034
Mailing Address - Fax:716-706-2035
Practice Address - Street 1:300 TWO MILE CREEK RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-6618
Practice Address - Country:US
Practice Address - Phone:716-447-6450
Practice Address - Fax:716-447-6486
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01988581Medicaid
R09707Medicare UPIN
NY01988581Medicaid