Provider Demographics
NPI:1518395383
Name:ELIZABETH MEDICAL PRACTICE LLC
Entity type:Organization
Organization Name:ELIZABETH MEDICAL PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HASHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-384-0008
Mailing Address - Street 1:214 S SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-1508
Mailing Address - Country:US
Mailing Address - Phone:412-384-0008
Mailing Address - Fax:412-384-5640
Practice Address - Street 1:214 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-1522
Practice Address - Country:US
Practice Address - Phone:412-384-0008
Practice Address - Fax:412-384-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049441-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty