Provider Demographics
NPI:1154705796
Name:RAZEGHINEJAD, REZA (MD)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:RAZEGHINEJAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMADREZA
Other - Middle Name:
Other - Last Name:RAZEGHINEJAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:840 WALNUT ST STE 1110
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-928-3197
Mailing Address - Fax:215-928-0166
Practice Address - Street 1:840 WALNUT ST STE 1110
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-928-3197
Practice Address - Fax:215-928-0166
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD462972207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist