Basic Information
Provider Information
NPI: 1851562896
EntityType: 2
ReplacementNPI:  
OrganizationName: ALI RAZI ANESTHESIA ASSOCIATES, PA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2411 W BELVEDERE AVE
Address2: SUITE 402
City: BALTIMORE
State: MD
PostalCode: 212155228
CountryCode: US
TelephoneNumber: 4106019258
FaxNumber: 4106019974
Practice Location
Address1: 2411 W BELVEDERE AVE
Address2: SUITE 402
City: BALTIMORE
State: MD
PostalCode: 212155228
CountryCode: US
TelephoneNumber: 4106019258
FaxNumber: 4106019974
Other Information
ProviderEnumerationDate: 03/18/2008
LastUpdateDate: 03/18/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RAZI
AuthorizedOfficialFirstName: ALI
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 4106018949
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XD0058379MDY193400000X SINGLE SPECIALTY GROUPOther Service ProvidersSpecialist 

ID Information
IDTypeStateIssuerDescription
PENDING05MD MEDICAID


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