Provider Demographics
NPI:1780656348
Name:RAZA, SALIM (MD)
Entity Type:Individual
Prefix:
First Name:SALIM
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 1:320 CLEVELAND DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1936
Mailing Address - Country:US
Mailing Address - Phone:716-836-6615
Mailing Address - Fax:716-836-6781
Practice Address - Street 1:320 CLEVELAND DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1936
Practice Address - Country:US
Practice Address - Phone:716-836-6615
Practice Address - Fax:716-836-6781
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111536-1208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00639950Medicaid
NYB71423Medicare UPIN
NY00639950Medicaid