Provider Demographics
NPI:1093969412
Name:NIAZI, SAIFULLAH KHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAIFULLAH
Middle Name:KHAN
Last Name:NIAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 CUTSHAW AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3630
Mailing Address - Country:US
Mailing Address - Phone:804-355-4545
Mailing Address - Fax:804-355-7805
Practice Address - Street 1:4906 CUTSHAW AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3630
Practice Address - Country:US
Practice Address - Phone:804-355-4545
Practice Address - Fax:804-355-7805
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010249682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1881647790Medicaid
VA1881647790Medicaid