Provider Demographics
NPI:1497846943
Name:RAZA, QUASIR (MD)
Entity Type:Individual
Prefix:
First Name:QUASIR
Middle Name:
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 1:6136 PETERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4063
Mailing Address - Country:US
Mailing Address - Phone:540-283-3660
Mailing Address - Fax:540-283-3677
Practice Address - Street 1:6136 PETERS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4063
Practice Address - Country:US
Practice Address - Phone:540-283-3660
Practice Address - Fax:540-283-3677
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101229844207R00000X
WV20696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497846943Medicaid
WV0001209006Medicaid
VA1497846943Medicaid
WV0001209006Medicaid
H60363Medicare UPIN
VA0076-1459Medicare ID - Type Unspecified
VA021782S90Medicare PIN
VA110008416Medicare ID - Type Unspecified
021099L84Medicare PIN
VAP00779068Medicare PIN