Provider Demographics
NPI:1588643241
Name:RAZA, SYED T (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:T
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:177 FORT WASHINGTON AVE
Mailing Address - Street 2:MHB 7-435 GN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3733
Mailing Address - Country:US
Mailing Address - Phone:212-305-3305
Mailing Address - Fax:212-305-2439
Practice Address - Street 1:177 FORT WASHINGTON AVE
Practice Address - Street 2:MHB 7-435 GN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:212-305-3305
Practice Address - Fax:212-305-2439
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV21832208G00000X
NY130643208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002488Medicaid
WVRA4155062Medicare ID - Type Unspecified
WVB71614Medicare UPIN