Healthcare Provider Details

I. General information

NPI: 1780656348
Provider Name (Legal Business Name): SALIM RAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 CLEVELAND DR
BUFFALO NY
14215-1936
US

IV. Provider business mailing address

320 CLEVELAND DR
BUFFALO NY
14215-1936
US

V. Phone/Fax

Practice location:
  • Phone: 716-836-6615
  • Fax: 716-836-6781
Mailing address:
  • Phone: 716-836-6615
  • Fax: 716-836-6781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number111536-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: