Provider Demographics
NPI:1396897948
Name:RAZVI, AGHA SADEQ (MD)
Entity type:Individual
Prefix:DR
First Name:AGHA
Middle Name:SADEQ
Last Name:RAZVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SADEQ
Other - Middle Name:A
Other - Last Name:RAZVI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2333 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:609-588-0400
Mailing Address - Fax:609-890-6935
Practice Address - Street 1:2333 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE #1
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:609-588-0400
Practice Address - Fax:609-890-6935
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41135207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1840304Medicaid
P421132OtherOXFORD
94955 & 577843OtherAETNA
NJ1840304Medicaid
P421132OtherOXFORD