Provider Demographics
NPI:1427011295
Name:RIAZ, RIAZ UDDIN (MD)
Entity type:Individual
Prefix:
First Name:RIAZ
Middle Name:UDDIN
Last Name:RIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 WINNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-7894
Mailing Address - Country:US
Mailing Address - Phone:304-952-8637
Mailing Address - Fax:304-952-8637
Practice Address - Street 1:315 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2421
Practice Address - Country:US
Practice Address - Phone:304-952-8637
Practice Address - Fax:866-239-0601
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA418182084P0800X
WV120802084P0800X
NC218552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0201433000Medicaid
VA7116934Medicaid
VA454028OtherANTHEM
VA454028OtherANTHEM
VABR6593140OtherDEA
WVBL9320291Medicare ID - Type UnspecifiedPALMETTO
VABR6593140OtherDEA