Healthcare Provider Details

I. General information

NPI: 1720345135
Provider Name (Legal Business Name): MOHAMMED A RAZVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8691 STONEWALL RD
MANASSAS VA
20110-4510
US

IV. Provider business mailing address

PO BOX 748613
ATLANTA GA
30374-8613
US

V. Phone/Fax

Practice location:
  • Phone: 571-833-7951
  • Fax: 571-833-7952
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101289787
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: