1326027301 NPI number — SYED A RAZA MD

Table of content: SYED A RAZA MD (NPI 1326027301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326027301 NPI number — SYED A RAZA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAZA
Provider First Name:
SYED
Provider Middle Name:
A
Provider Name Prefix Text:
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:
1326027301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4127
Provider Second Line Business Mailing Address:
VALLEY INTERNAL MEDICINE PC
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-344-9779
Provider Business Mailing Address Fax Number:
540-344-7154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3737 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-380-3722
Provider Business Practice Location Address Fax Number:
540-380-3725
Provider Enumeration Date:
01/10/2006

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:  0101230264 , 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: 110223202 . This is a "MCRR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00589352 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 434580 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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