Healthcare Provider Details

I. General information

NPI: 1457790479
Provider Name (Legal Business Name): SARA CHOWDHURY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # 49
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

450 CLARKSON AVE # 49
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1912
  • Fax: 718-270-1985
Mailing address:
  • Phone: 718-270-1912
  • Fax: 718-270-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT205266
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number290230
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: