MEDICARE: AMOL RAIZADA

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	207R00000X	Internal Medicine Physician	MT183305	PA
2	207RC0000X	Cardiovascular Disease Physician	0101262595	VA
3	207RI0011X	Interventional Cardiology Physician	0101262595	VA

General Provider Information

NPI Number	:	1467660597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMOL RAIZADA

Provider Business Mailing Address
First Line	:	1031 LOFTIS BLVD STE 100
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-2981
Country	:	US
Telephone Number	:	757-736-9860
Fax Number	:	757-240-5537

Provider Business Practice Location Address
First Line	:	1031 LOFTIS BLVD STE 100
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-2981
Country	:	US
Telephone Number	:	757-736-9860
Fax Number	:	757-240-5537

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	10/09/2020

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Directions to “ AMOL RAIZADA ” Practice Location

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