Provider Demographics
NPI:1841305612
Name:PRADEEPTA CHOWDHURY, MD, LLC
Entity type:Organization
Organization Name:PRADEEPTA CHOWDHURY, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRADEEPTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-961-3404
Mailing Address - Street 1:670 PONAHAWAI ST
Mailing Address - Street 2:STE 116
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7831
Mailing Address - Country:US
Mailing Address - Phone:808-961-3404
Mailing Address - Fax:808-961-5460
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:STE 116
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7831
Practice Address - Country:US
Practice Address - Phone:808-961-3404
Practice Address - Fax:808-961-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10069261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00121202Medicaid
HI10069OtherOTHER INSURANCES
HIF16530Medicare UPIN
HI00121202Medicaid