Provider Demographics
NPI:1104010453
Name:RAZZAQ, ZIA (DSC,CMT,LLCC,NCTMB)
Entity Type:Individual
Prefix:DR
First Name:ZIA
Middle Name:
Last Name:RAZZAQ
Suffix:
Gender:M
Credentials:DSC,CMT,LLCC,NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 CHESWICK LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6559
Mailing Address - Country:US
Mailing Address - Phone:757-615-2124
Mailing Address - Fax:
Practice Address - Street 1:3322 VIRGINIA BEACH BLVD STE 120
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5608
Practice Address - Country:US
Practice Address - Phone:757-615-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019 005511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist