Provider Demographics
NPI:1013048354
Name:SYED M RIZVI MD LLC
Entity Type:Organization
Organization Name:SYED M RIZVI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-291-2269
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-0162
Mailing Address - Country:US
Mailing Address - Phone:610-291-2269
Mailing Address - Fax:
Practice Address - Street 1:340 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5505
Practice Address - Country:US
Practice Address - Phone:610-891-5840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4216412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1642940OtherHIGHMARK BLUE SHIELD
2862828000OtherAMERIHEALTH PPO
7401590OtherAETNA
1948986OtherPREMIER BLUE
1948986OtherPREMIER BLUE
PA109352Medicare PIN