Provider Demographics
NPI:1528056389
Name:NIAZ, QAISER (MD)
Entity type:Individual
Prefix:
First Name:QAISER
Middle Name:
Last Name:NIAZ
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 1:4721 DALLAS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8811
Mailing Address - Country:US
Mailing Address - Phone:925-778-0679
Mailing Address - Fax:925-778-3567
Practice Address - Street 1:27206 CALAROGA AVE
Practice Address - Street 2:#208
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4300
Practice Address - Country:US
Practice Address - Phone:510-264-0300
Practice Address - Fax:510-264-9510
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11201207R00000X, 207RH0000X
AL28392207RH0003X
KY43954207RH0003X
CAC55286207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009912297Medicaid
AL510-07035OtherBCBS
KY7100146950Medicaid
AL510I830002OtherMEDICARE
I26169Medicare UPIN