Healthcare Provider Details

I. General information

NPI: 1750771085
Provider Name (Legal Business Name): SYDUR RAHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 GROVE RD STE M123
PITTSBURGH PA
15236-5602
US

IV. Provider business mailing address

1600 SW ARCHER ROAD
GAINESVILLE FL
32608
US

V. Phone/Fax

Practice location:
  • Phone: 412-677-9100
  • Fax: 506-804-1021
Mailing address:
  • Phone: 352-265-7337
  • Fax: 506-804-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD485683
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: