Basic Information
| Provider Information | |||||||||
| NPI: | 1407099112 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAZAVI | ||||||||
| FirstName: | FARID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 REED AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196102002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103744401 | ||||||||
| FaxNumber: | 6103747916 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 REED AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196102002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103744401 | ||||||||
| FaxNumber: | 6103747916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2009 | ||||||||
| LastUpdateDate: | 06/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD454386 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.