Provider Demographics
NPI:1285734715
Name:RAZA, SYED SAMAR (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:SAMAR
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2 DEWBERRY CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5655
Mailing Address - Country:US
Mailing Address - Phone:631-433-0335
Mailing Address - Fax:
Practice Address - Street 1:301 E MAIN ST
Practice Address - Street 2:HOSPITALIST DEPARTMENT - 3 TOWER
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8408
Practice Address - Country:US
Practice Address - Phone:631-968-3503
Practice Address - Fax:631-968-3716
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY235799208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY148749Medicare UPIN
NY148749Medicare UPIN