Provider Demographics
NPI:1205098910
Name:SHAH, RAZA (MD)
Entity type:Individual
Prefix:
First Name:RAZA
Middle Name:
Last Name:SHAH
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 1:2919 OLNEY SANDY SPRING RD STE D
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1589
Mailing Address - Country:US
Mailing Address - Phone:301-876-4900
Mailing Address - Fax:240-483-4493
Practice Address - Street 1:2919 OLNEY SANDY SPRING RD STE D
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:301-876-4900
Practice Address - Fax:240-483-4493
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO070196207W00000X
DCMD046226207WX0107X
PAMT193230207R00000X
AZ47350207W00000X
WV26983207WX0107X
PAMD455997207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0070196OtherMEDICAL BOARD
DCMD046226OtherMEDICAL BOARD
MT193230OtherMEDICAL TRAINING
PAMD455997OtherMEDICAL BOARD