Provider Demographics
NPI:1003026329
Name:RAZDAN, RISHI NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RISHI
Middle Name:NORMAN
Last Name:RAZDAN
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 1:40 VALLEY STREAM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1407
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:
Practice Address - Street 1:2416 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4604
Practice Address - Country:US
Practice Address - Phone:904-353-3664
Practice Address - Fax:904-353-3858
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2659842085R0202X, 2085R0204X
CT0483782085R0204X
FLME1333842085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03499396Medicaid
NYA400074614Medicare PIN
NYA400074611Medicare PIN
NYA400074612Medicare PIN
CT0400089965Medicare PIN
NYA400074610Medicare PIN