Provider Demographics
NPI:1699859512
Name:RAZDAN, DOLLY (MD)
Entity Type:Individual
Prefix:
First Name:DOLLY
Middle Name:
Last Name:RAZDAN
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 1:1 CLARA MAASS DR
Mailing Address - Street 2:RADIATION ONCOLOGY
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3550
Mailing Address - Country:US
Mailing Address - Phone:973-450-2270
Mailing Address - Fax:973-844-4904
Practice Address - Street 1:1 CLARA MAASS DR
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3550
Practice Address - Country:US
Practice Address - Phone:973-450-2270
Practice Address - Fax:973-844-4904
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA059919002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6011900Medicaid
NJ6011900Medicaid
NJ895426Medicare PIN