Provider Demographics
NPI:1154521326
Name:FERDOUS, RAZIA KHAN (MD)
Entity type:Individual
Prefix:
First Name:RAZIA
Middle Name:KHAN
Last Name:FERDOUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1409
Mailing Address - Country:US
Mailing Address - Phone:718-945-7150
Mailing Address - Fax:718-945-2596
Practice Address - Street 1:540 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1985
Practice Address - Country:US
Practice Address - Phone:718-855-4900
Practice Address - Fax:718-802-0631
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY245230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02938856Medicaid
NYA400020844Medicare PIN
NY2364499072Medicare PIN