Healthcare Provider Details

I. General information

NPI: 1205098910
Provider Name (Legal Business Name): RAZA SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 OLNEY SANDY SPRING RD STE D
OLNEY MD
20832
US

IV. Provider business mailing address

2919 OLNEY SANDY SPRING RD STE D
OLNEY MD
20832-1589
US

V. Phone/Fax

Practice location:
  • Phone: 301-876-4900
  • Fax: 240-483-4493
Mailing address:
  • Phone: 301-876-4900
  • Fax: 240-483-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT193230
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDO070196
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number47350
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD046226
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number26983
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberMD455997
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: