MEDICARE: DR. RISHI NORMAN RAZDAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	265984	NY
2	2085R0204X	Vascular & Interventional Radiology Physician	265984	NY
3	2085R0204X	Vascular & Interventional Radiology Physician	048378	CT
4	2085R0204X	Vascular & Interventional Radiology Physician	ME133384	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003026329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RISHI NORMAN RAZDAN MD

Provider Business Mailing Address
First Line	:	40 VALLEY STREAM PKWY STE 100
Second Line	:
City	:	MALVERN
State	:	PA
Zip	:	19355-1407
Country	:	US
Telephone Number	:	610-644-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 DUNN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4604
Country	:	US
Telephone Number	:	904-353-3664
Fax Number	:	904-353-3858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	04/24/2020

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