Healthcare Provider Details

I. General information

NPI: 1306475405
Provider Name (Legal Business Name): RAZA TARIQ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PECAN ST SE
WASHINGTON DC
20032-2652
US

IV. Provider business mailing address

PO BOX 392220
PITTSBURGH PA
15251-9220
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD600004379
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: