=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033350426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAHBOOBUR RAHMAN MD & GOPA RAHMAN MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2009
-----------------------------------------------------
Last Update Date | 03/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 243 NORTH RD SUITE 201N
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12601-1172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-454-0370
-----------------------------------------------------
Fax | 845-454-6017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 243 NORTH RD SUITE 201N
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12601-1172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-454-0370
-----------------------------------------------------
Fax | 845-454-6017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | MAHBOOBUR RAHMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 845-454-0370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 190938
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 188444
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------