Provider Demographics
NPI:1174956387
Name:RIZVI, SYED SHAMSHAD ALI (MD)
Entity type:Individual
Prefix:
First Name:SYED SHAMSHAD ALI
Middle Name:
Last Name:RIZVI
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 1:136 W ELIZABETH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-3811
Mailing Address - Country:US
Mailing Address - Phone:540-564-5100
Mailing Address - Fax:844-305-4862
Practice Address - Street 1:136 W ELIZABETH ST STE 102
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-3811
Practice Address - Country:US
Practice Address - Phone:540-564-5100
Practice Address - Fax:844-305-4862
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012623852084P0800X
OH57.0224232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174956387Medicaid