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General NPI Number Information
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NPI Number | 1871732867
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Entity Type | Organization
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Legal Business Name | SYED RAZA MD PSC
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 02/13/2009
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Provider Practice Location Address
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Address Line | 110 PROFESSIONAL LN
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City | HARLAN
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State | KY
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Zip | 40831-2590
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Country | US
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Telephone | 606-573-8320
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 360
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City | GRAYS KNOB
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State | KY
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Zip | 40829-0360
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Country | US
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Telephone | 606-573-2398
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Fax | 606-574-9995
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Authorized Official
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Title or Position | PRESIDENT
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Name | SYED RAZA
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Credential | M.D.
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Telephone | 606-573-2398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 36481
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License Number State | KY
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