Provider Demographics
NPI:1982648291
Name:CHOWDHURY, TAJUL S (MD)
Entity Type:Individual
Prefix:DR
First Name:TAJUL
Middle Name:S
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 1:2637 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8479
Mailing Address - Country:US
Mailing Address - Phone:956-631-9041
Mailing Address - Fax:956-972-0549
Practice Address - Street 1:2637 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8479
Practice Address - Country:US
Practice Address - Phone:956-631-9041
Practice Address - Fax:956-972-0549
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6486207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742780495OtherTAX IDENTIFICATION NUMBER
TX85Z780OtherBLUE CROSS/BLUE SHIELD #
TX085535502Medicaid
TXD87090Medicare UPIN
TX85Z780Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER