1346238961 NPI number — SYED FARHAN MAHMOOD RIZVI M.D.

Table of content: SYED FARHAN MAHMOOD RIZVI M.D. (NPI 1346238961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346238961 NPI number — SYED FARHAN MAHMOOD RIZVI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIZVI
Provider First Name:
SYED
Provider Middle Name:
FARHAN MAHMOOD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1346238961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 LEE PARKWAY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-1741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-855-2552
Provider Business Mailing Address Fax Number:
423-855-9041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2341 MCCALLIE AVE
Provider Second Line Business Practice Location Address:
PLAZA 3, SUITE 403
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37404-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-697-4567
Provider Business Practice Location Address Fax Number:
423-697-0047
Provider Enumeration Date:
10/07/2005

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:  031337 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000902987B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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