Healthcare Provider Details

I. General information

NPI: 1932116241
Provider Name (Legal Business Name): ALI RAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 KEY PKWY STE 103
FREDERICK MD
21702-4496
US

IV. Provider business mailing address

8721 LAKE EDGE DR
LAUREL MD
20723-4908
US

V. Phone/Fax

Practice location:
  • Phone: 240-629-3939
  • Fax: 240-629-3940
Mailing address:
  • Phone: 410-236-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0058379
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: