Provider Demographics
NPI:1780791137
Name:RAZVI, SYED ASIF (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:ASIF
Last Name:RAZVI
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 1:11 NEVINS ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3514
Mailing Address - Country:US
Mailing Address - Phone:617-254-4200
Mailing Address - Fax:617-254-4242
Practice Address - Street 1:11 NEVINS ST
Practice Address - Street 2:SUITE 308
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:617-254-4200
Practice Address - Fax:617-254-4242
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34728208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA034728OtherTUFTS
MA2015579Medicaid
MAM08247OtherBLUE SHIELD
MA8415OtherHARVARD PILGRIM
MA8415OtherHARVARD PILGRIM
MAM08247OtherBLUE SHIELD