Healthcare Provider Details

I. General information

NPI: 1700868734
Provider Name (Legal Business Name): RIZWAN PASHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6149 CHANCELLOR DR STE 2780
ORLANDO FL
32809
US

IV. Provider business mailing address

PO BOX 5183
MERIDIAN MS
39302-5183
US

V. Phone/Fax

Practice location:
  • Phone: 407-352-2542
  • Fax: 407-352-2547
Mailing address:
  • Phone: 601-703-4282
  • Fax: 601-703-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME132396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: