Healthcare Provider Details

I. General information

NPI: 1386139988
Provider Name (Legal Business Name): MEDHAT RAFIQUE CHOWDHURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2321
US

IV. Provider business mailing address

695 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2321
US

V. Phone/Fax

Practice location:
  • Phone: 386-258-8722
  • Fax: 386-258-8659
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME180880
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME180880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: