Healthcare Provider Details

I. General information

NPI: 1174757959
Provider Name (Legal Business Name): NIDA BUTOOL RIZVI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S GEORGE ST FL 4
YORK PA
17403-3676
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-4005
  • Fax: 717-812-2495
Mailing address:
  • Phone: 717-851-4005
  • Fax: 717-812-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD446768
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD446768
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: