Healthcare Provider Details

I. General information

NPI: 1689835407
Provider Name (Legal Business Name): HANIYA RAZA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DRIVE 6-5340 MSC 1276 NIMH/NIH
BETHESDA MD
20892-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW STE 1200
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-4000
  • Fax:
Mailing address:
  • Phone: 202-476-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberH0063376
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberH63376
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberDO034248
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDO034248
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberH63376
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: