Healthcare Provider Details

I. General information

NPI: 1386740967
Provider Name (Legal Business Name): MOHAMED S RAZACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MAIN ST
BUFFALO NY
14214-2635
US

IV. Provider business mailing address

9568 WICKHAM WAY
ORLANDO FL
32836-5526
US

V. Phone/Fax

Practice location:
  • Phone: 716-832-9445
  • Fax: 716-838-3022
Mailing address:
  • Phone: 407-612-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberNY117819-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: