Healthcare Provider Details

I. General information

NPI: 1841305612
Provider Name (Legal Business Name): PRADEEPTA CHOWDHURY, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PONAHAWAI ST STE 116
HILO HI
96720-7831
US

IV. Provider business mailing address

670 PONAHAWAI ST STE 116
HILO HI
96720-7831
US

V. Phone/Fax

Practice location:
  • Phone: 808-961-3404
  • Fax: 808-961-5460
Mailing address:
  • Phone: 808-961-3404
  • Fax: 808-961-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number10069
License Number StateHI

VIII. Authorized Official

Name: DR. PRADEEPTA CHOWDHURY
Title or Position: OWNER
Credential: MD
Phone: 808-961-3404