Basic Information
| Provider Information | |||||||||
| NPI: | 1932190451 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAJA | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | ISHTIAQ | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 980663 | ||||||||
| Address2: | MCV. 1001 EAST BROAD STREET | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232980663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048285323 | ||||||||
| FaxNumber: | 8048288660 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 EAST BROAD STREET | ||||||||
| Address2: | MCV PHYSICIANS | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043274046 | ||||||||
| FaxNumber: | 8043274047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 09/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101237545 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010228981 | 05 | VA | MEDICAID | 1932190451 | 05 | VA | MEDICAID |