Provider Demographics
NPI:1942215751
Name:CHOWDHURY, TABASSUM A (MD)
Entity Type:Individual
Prefix:DR
First Name:TABASSUM
Middle Name:A
Last Name:CHOWDHURY
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 1:5959 TRUXTUN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0435
Mailing Address - Country:US
Mailing Address - Phone:661-324-1203
Mailing Address - Fax:661-324-3195
Practice Address - Street 1:5959 TRUXTUN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0435
Practice Address - Country:US
Practice Address - Phone:661-324-1203
Practice Address - Fax:661-324-3195
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60318174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A603180Medicaid
CA00A603180Medicare ID - Type UnspecifiedMEDICARE
CA00A603180Medicaid