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General NPI Number Information
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NPI Number | 1841305612
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Entity Type | Organization
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Legal Business Name | PRADEEPTA CHOWDHURY, MD, LLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 670 PONAHAWAI ST STE 116
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City | HILO
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State | HI
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Zip | 96720-7831
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Country | US
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Telephone | 808-961-3404
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Fax | 808-961-5460
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Provider Business Mailing Address
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Address Line | 670 PONAHAWAI ST STE 116
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City | HILO
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State | HI
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Zip | 96720-7831
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Country | US
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Telephone | 808-961-3404
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Fax | 808-961-5460
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRADEEPTA CHOWDHURY
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Credential | MD
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Telephone | 808-961-3404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 10069
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License Number State | HI
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