MEDICARE: JOHN M RAZOOK MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207U00000X	Nuclear Medicine Physician	20940	SC
2	2085B0100X	Body Imaging Physician	20940	SC
3	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	20940	SC
4	2085N0904X	Nuclear Radiology Physician	20940	SC
5	2085P0229X	Pediatric Radiology Physician	20940	SC
6	2085R0001X	Radiation Oncology Physician	20940	SC
7	2085R0203X	Therapeutic Radiology Physician	20940	SC
8	2085R0204X	Vascular & Interventional Radiology Physician	20940	SC
9	2085R0205X	Radiological Physics Physician	20940	SC
10	2085U0001X	Diagnostic Ultrasound Physician	20940	SC
11	2085N0700X	Neuroradiology Physician	20940	SC
12	2085R0202X	Diagnostic Radiology Physician	20940	SC

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

NPI Number	:	1669458659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN M RAZOOK MD

Provider Business Mailing Address
First Line	:	700 E MOREHEAD ST STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-2742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 ASSEMBLY ST STE B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3121
Country	:	US
Telephone Number	:	803-766-3009
Fax Number	:

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	02/07/2024