Healthcare Provider Details

I. General information

NPI: 1932190451
Provider Name (Legal Business Name): MUHAMMAD ISHTIAQ RAJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EAST BROAD STREET MCV PHYSICIANS
RICHMOND VA
23298
US

IV. Provider business mailing address

P.O. BOX 980663 MCV. 1001 EAST BROAD STREET
RICHMOND VA
23298-0663
US

V. Phone/Fax

Practice location:
  • Phone: 804-327-4046
  • Fax: 804-327-4047
Mailing address:
  • Phone: 804-828-5323
  • Fax: 804-828-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101237545
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: