Provider Demographics
NPI:1053990622
Name:RAZA, FAJAR (MD)
Entity type:Individual
Prefix:
First Name:FAJAR
Middle Name:
Last Name:RAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:646 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5322
Mailing Address - Country:US
Mailing Address - Phone:203-784-8700
Mailing Address - Fax:203-784-8703
Practice Address - Street 1:646 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5322
Practice Address - Country:US
Practice Address - Phone:203-784-8700
Practice Address - Fax:203-784-8703
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2025-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT803522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry