Provider Demographics
NPI:1245326941
Name:RAZI, NIOSHA (MD)
Entity type:Individual
Prefix:DR
First Name:NIOSHA
Middle Name:
Last Name:RAZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10013 BENTCROSS DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4739
Mailing Address - Country:US
Mailing Address - Phone:301-370-0794
Mailing Address - Fax:410-764-0647
Practice Address - Street 1:6615 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2686
Practice Address - Country:US
Practice Address - Phone:410-764-0912
Practice Address - Fax:310-388-3029
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00616042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD460771600Medicaid
MD460771600Medicaid