Healthcare Provider Details

I. General information

NPI: 1922091685
Provider Name (Legal Business Name): QAMRUNNISA RAHMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TWO MILE CREEK RD
TONAWANDA NY
14150-6618
US

IV. Provider business mailing address

2875 UNION RD SUITE 21
CHEEKTOWAGA NY
14227-1470
US

V. Phone/Fax

Practice location:
  • Phone: 716-447-6450
  • Fax: 716-447-6486
Mailing address:
  • Phone: 716-706-2034
  • Fax: 716-706-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number213653
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: