1932190451 NPI number — MR. MUHAMMAD ISHTIAQ RAJA MD

Table of content: MR. MUHAMMAD ISHTIAQ RAJA MD (NPI 1932190451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932190451 NPI number — MR. MUHAMMAD ISHTIAQ RAJA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAJA
Provider First Name:
MUHAMMAD
Provider Middle Name:
ISHTIAQ
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932190451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 980663
Provider Second Line Business Mailing Address:
MCV. 1001 EAST BROAD STREET
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23298-0663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-828-5323
Provider Business Mailing Address Fax Number:
804-828-8660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 EAST BROAD STREET
Provider Second Line Business Practice Location Address:
MCV PHYSICIANS
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-327-4046
Provider Business Practice Location Address Fax Number:
804-327-4047
Provider Enumeration Date:
11/03/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101237545 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010228981 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1932190451 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".