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NPI Code Detail

MEDICARE: RAISA AMIRUDDIN

MEDICARE: RAISA AMIRUDDIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramMA

General Provider Information

NPI Number : 1295677284
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAISA AMIRUDDIN
Provider Business Mailing Address
First Line : 4127 WOODLAND AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-4510
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 115 LINCOLN ST
Second Line :
City : FRAMINGHAM
State : MA
Zip : 01702-6358
Country : US
Telephone Number : 508-383-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2026
Last Update Date : 04/08/2026

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Directions to “ RAISA AMIRUDDIN ” Practice Location

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