Provider Demographics
NPI:1356313563
Name:BAZAZ, RAVEEN
Entity type:Individual
Prefix:
First Name:RAVEEN
Middle Name:
Last Name:BAZAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2768
Mailing Address - Country:US
Mailing Address - Phone:724-689-1355
Mailing Address - Fax:724-689-0544
Practice Address - Street 1:44 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2768
Practice Address - Country:US
Practice Address - Phone:724-689-1355
Practice Address - Fax:724-689-0544
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421402207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001959979Medicaid
PA070507D9JMedicare ID - Type Unspecified