Provider Demographics
NPI:1467562371
Name:RAZA, MUDUSAR I (MD)
Entity Type:Individual
Prefix:
First Name:MUDUSAR
Middle Name:I
Last Name:RAZA
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 1:12821 OAK HILL AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2940
Mailing Address - Country:US
Mailing Address - Phone:301-733-0300
Mailing Address - Fax:301-733-5773
Practice Address - Street 1:12821 OAK HILL AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2940
Practice Address - Country:US
Practice Address - Phone:301-733-0300
Practice Address - Fax:301-733-5773
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053707174400000X
MDD66166207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD91623801OtherCAREFIRST BCBS
MD413617900Medicaid
DC74960005OtherCAREFIRST BCBS
DC74960005OtherCAREFIRST BCBS
MD91623801OtherCAREFIRST BCBS
MDP00469001Medicare PIN