Healthcare Provider Details

I. General information

NPI: 1578204293
Provider Name (Legal Business Name): REHAN KHALID RAZZAQ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N 11TH ST
RICHMOND VA
23298-5024
US

IV. Provider business mailing address

1101 E MARSHALL ST RM 1-010L
RICHMOND VA
23298-5008
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9357
  • Fax: 804-828-7591
Mailing address:
  • Phone: 804-628-4907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102209276
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: