Provider Demographics
NPI:1033128137
Name:RIZVI, SYED M (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:M
Last Name:RIZVI
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 1:1 W ELM ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-291-2269
Mailing Address - Fax:
Practice Address - Street 1:525 WEST CHESTER PIKE
Practice Address - Street 2:SUITE 305
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4510
Practice Address - Country:US
Practice Address - Phone:610-446-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3209782084P0800X
PAMD4216412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA729451000OtherMIS
7401590OtherAETNA
PA1642940OtherBLUE SHIELD
PA2317211000OtherPERSONAL CHOICE
2862828000OtherAMERIHEALTH PPO
PA1010444600001Medicaid
072196WBZMedicare PIN
7401590OtherAETNA
PA1642940OtherBLUE SHIELD