MEDICARE: DR. RABIA RIZWANA M.D.

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	2084N0400X	Neurology Physician	252652	NY
2	2084N0600X	Clinical Neurophysiology Physician	252652	NY

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

General Provider Information

NPI Number	:	1922254408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RABIA RIZWANA M.D.

Provider Business Mailing Address
First Line	:	1101 ERIE BLVD E
Second Line	:	SUITE 204
City	:	SYRACUSE
State	:	NY
Zip	:	13210-1148
Country	:	US
Telephone Number	:	315-472-9554
Fax Number	:	315-472-9553

Provider Business Practice Location Address
First Line	:	1101 ERIE BLVD E
Second Line	:	SUITE 204
City	:	SYRACUSE
State	:	NY
Zip	:	13210-1148
Country	:	US
Telephone Number	:	315-472-9554
Fax Number	:	315-472-9553

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

Provider Enumeration Date	:	08/15/2008
Last Update Date	:	02/12/2011

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