Provider Demographics
NPI:1366556995
Name:CHOWDHURY, PROSANTI K (MD)
Entity type:Individual
Prefix:
First Name:PROSANTI
Middle Name:K
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:6316 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2766
Practice Address - Country:US
Practice Address - Phone:817-605-2504
Practice Address - Fax:817-605-2505
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7547208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0003GSOtherBCBSTX GRP PIN
1124098447OtherGRP NPI NUMBER
TX132354503Medicaid
TX1643090OtherCIGNA PIN
TX7387029OtherAETNA PIN
TX8B2070OtherBCBSTX IND PIN
TX080626701Medicaid
TX1908205OtherFIRSTHEALTH PIN
TX816515OtherUHC PIN
TX816515OtherUHC PIN
TX132354503Medicaid
1124098447OtherGRP NPI NUMBER
TX8189K2Medicare PIN