Provider Demographics
NPI:1326027301
Name:RAZA, SYED A (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:A
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:VALLEY INTERNAL MEDICINE PC
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015
Mailing Address - Country:US
Mailing Address - Phone:540-344-9779
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:3737 WEST MAIN STREET
Practice Address - Street 2:#102
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-380-3722
Practice Address - Fax:540-380-3725
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101230264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110223202OtherMCRR
VA00589352Medicaid
434580OtherANTHEM
110008107Medicare PIN
110223202OtherMCRR