Provider Demographics
NPI:1770591455
Name:RAHMAN, MOHAMMAD ANISUR (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ANISUR
Last Name:RAHMAN
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 1:1039 SPOTSWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5492
Mailing Address - Country:US
Mailing Address - Phone:347-574-5585
Mailing Address - Fax:706-823-3960
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:706-823-3960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132633208100000X
NJ25MA06837700208100000X
NY213014208100000X
GA86643208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1677409-003OtherCIGNA INSURANCE
NY275060OtherWELL CARE
NY2I205OtherBLUE CROSS, BLUE SHIELD
NY4C3393OtherHEALTH-NET
NY7664365OtherAETNA POS AND PPO
NY2166811OtherUNITED HEALTH CARE -COMME
NY2300691OtherUNITED HEALTHCARE GOVRNME
NYP2577111OtherOXFORD HEALTH PLANS
NY2879068OtherAETNA HMO
NY2300691OtherUNITED HEALTHCARE GOVRNME
NY275060OtherWELL CARE
NY1000033963OtherAFFINITY INSURANCE
NY4C3393OtherHEALTH-NET
NY2I205OtherBLUE CROSS, BLUE SHIELD
NY02194829Medicaid
NY2879068OtherAETNA HMO
NY52139POtherHIP
NY7664365OtherAETNA POS AND PPO
NY02194829Medicaid
NY02194829Medicaid