Healthcare Provider Details

I. General information

NPI: 1356313563
Provider Name (Legal Business Name): RAVEEN BAZAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S WASHINGTON AVE
GREENSBURG PA
15601-2768
US

IV. Provider business mailing address

44 S WASHINGTON AVE
GREENSBURG PA
15601-2768
US

V. Phone/Fax

Practice location:
  • Phone: 724-836-1862
  • Fax: 724-689-0543
Mailing address:
  • Phone: 724-836-1862
  • Fax: 724-689-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD421402
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: