Healthcare Provider Details

I. General information

NPI: 1598861031
Provider Name (Legal Business Name): SERGEI E RAZOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

71 ANDREW ST
NEWTON MA
02461-2144
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-6324
  • Fax:
Mailing address:
  • Phone: 617-332-5941
  • Fax: 781-744-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number209049
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: