Provider Demographics
NPI:1003871963
Name:NAZIR, RAJA A (MD)
Entity Type:Individual
Prefix:
First Name:RAJA
Middle Name:A
Last Name:NAZIR
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 1:540 LINCOLN PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6401
Mailing Address - Country:US
Mailing Address - Phone:937-298-8058
Mailing Address - Fax:937-298-5638
Practice Address - Street 1:630 W MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2171
Practice Address - Country:US
Practice Address - Phone:937-283-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-0473N207RC0000X
OH35070473207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2321080Medicaid
OHH363270Medicare PIN
060067605Medicare PIN
OH2321080Medicaid
OH4070634Medicare PIN
OH4070631Medicare PIN