Provider Demographics
NPI:1932190451
Name:RAJA, MUHAMMAD ISHTIAQ (MD)
Entity Type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:ISHTIAQ
Last Name:RAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 980663
Mailing Address - Street 2:MCV. 1001 EAST BROAD STREET
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0663
Mailing Address - Country:US
Mailing Address - Phone:804-828-5323
Mailing Address - Fax:804-828-8660
Practice Address - Street 1:1200 EAST BROAD STREET
Practice Address - Street 2:MCV PHYSICIANS
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298
Practice Address - Country:US
Practice Address - Phone:804-327-4046
Practice Address - Fax:804-327-4047
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101237545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010228981Medicaid
VA1932190451Medicaid
P00276796Medicare PIN
VA009207V16Medicare PIN