Healthcare Provider Details

I. General information

NPI: 1609027697
Provider Name (Legal Business Name): SAKEENA RAZA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WAMPANOAG TRL SUITE 102
RIVERSIDE RI
02915-2212
US

IV. Provider business mailing address

17 VIRGINIA AVE SUITE 107
PROVIDENCE RI
02905-4406
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-4010
  • Fax: 401-649-4011
Mailing address:
  • Phone: 401-443-4992
  • Fax: 401-784-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number929522324
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD15282
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: