Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | MD456617 | PA |
NPI | 1144480153 |
---|---|
Provider Name | Dr. Shariq Syed Raza |
First Address | Philadelphia, PA 19104 |
Second Address | Philadelphia, PA 19140-4105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 13/05/2016 |