Healthcare Provider Details

I. General information

NPI: 1891114393
Provider Name (Legal Business Name): KHADIJA RAZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2014
Last Update Date: 07/02/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MITCHELL AVE FL 3
BINGHAMTON NY
13903
US

IV. Provider business mailing address

33 LEWIS RD 2ND FL
BINGHAMTON NY
13905
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-0639
  • Fax:
Mailing address:
  • Phone: 607-729-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number290153
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number290153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: