Healthcare Provider Details

I. General information

NPI: 1841452307
Provider Name (Legal Business Name): CHRISTIE L RAZAVI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 JACOBSBURG RD
WIND GAP PA
18091-9788
US

IV. Provider business mailing address

3435 WINCHESTER RD
ALLENTOWN PA
18104-2268
US

V. Phone/Fax

Practice location:
  • Phone: 610-452-3000
  • Fax:
Mailing address:
  • Phone: 610-861-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036139120
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberPENDING
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD466032
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: