Provider Demographics
NPI:1396747549
Name:CHOWDHURY, IMRAN H (MD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:H
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 1:9784 OLD ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6327
Mailing Address - Country:US
Mailing Address - Phone:410-997-1336
Mailing Address - Fax:410-997-1636
Practice Address - Street 1:10802 HICKORY RIDGE RD
Practice Address - Street 2:STE 310
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3622
Practice Address - Country:US
Practice Address - Phone:410-997-1336
Practice Address - Fax:410-997-1636
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0178052OtherGHI
NY1854746Medicaid
DCN1510001OtherBLUE CROSS FEDERAL
MD1013393OtherCOVENTRY
MD5702OtherELDER HEALTH
MD88624OtherAMERICAID
MD92-00121OtherEVERCARE
MD1114986OtherAETNA HMO
MD328881100Medicaid
MD4564479OtherAETNA OTHER
MDP00288291OtherRAILROAD
MD1936481OtherUNITED HEALTHCARE
VA244618OtherBLUE CROSS OF TRIGON
MD459053OtherALLIANCE
MD61077802OtherBLUE CROSS OF MARYLAND
MD770390OtherNATIONAL CAPITAL PPO
MD88624OtherAMERIGROUP
GA099956794AMedicaid
DC027476300Medicaid
MD4410647001OtherCIGNA
MD459053OtherMAMSI
NC7615904Medicaid
VA187126OtherANTHEM BLUE CROSS
MD494016OtherUS HEALTHCARE
MD9200849OtherAMERICHOICE
MD88624OtherAMERICAID
GA099956794AMedicaid