Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01068828A. | IN |
Y | 207Q00000X | Family Doctor | 43704 | KY |
N | 207Q00000X | Family Doctor | MT194879 | PA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 43704 | KY |
NPI | 1043445927 |
---|---|
Provider Name | Mohammed Akhlack Hossain Mazumder |
First Address | Prestonsburg, KY 41653-8300 |
Second Address | Prestonsburg, KY 41653-8569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2009 |
Last Update Date | 22/08/2018 |