Provider Demographics
NPI:1407003262
Name:RAZZAQ, KANWAL (MD)
Entity Type:Individual
Prefix:
First Name:KANWAL
Middle Name:
Last Name:RAZZAQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CHERRY ST
Mailing Address - Street 2:BLDG A, STE 104A
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3338
Mailing Address - Country:US
Mailing Address - Phone:304-325-1992
Mailing Address - Fax:304-327-1839
Practice Address - Street 1:510 CHERRY ST
Practice Address - Street 2:BLDG A, STE 104A
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3338
Practice Address - Country:US
Practice Address - Phone:304-325-1992
Practice Address - Fax:304-327-1839
Is Sole Proprietor?:No
Enumeration Date:2008-08-24
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25388207R00000X, 207RI0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease