Provider Demographics
NPI:1902193394
Name:RIZVI, RABA (MD)
Entity Type:Individual
Prefix:
First Name:RABA
Middle Name:
Last Name:RIZVI
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 1:1425 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-4101
Mailing Address - Fax:585-922-3894
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-4101
Practice Address - Fax:585-922-3894
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03007054/RGHMedicaid
NY01131126/RGHMedicaid
NY03007072/RGHMedicaid
NY03406397/WNYMedicaid
NYJ400171013Medicare PIN
NY03406397/WNYMedicaid
NYJ400171004Medicare PIN
NY70005A/RGHMedicare PIN