Provider Demographics
NPI:1366428567
Name:AWAN, RAZIA S (MD)
Entity type:Individual
Prefix:
First Name:RAZIA
Middle Name:S
Last Name:AWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAZIA
Other - Middle Name:S
Other - Last Name:ZUBAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2239
Mailing Address - Country:US
Mailing Address - Phone:732-742-0727
Mailing Address - Fax:973-923-6599
Practice Address - Street 1:156 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2016
Practice Address - Country:US
Practice Address - Phone:973-926-5853
Practice Address - Fax:973-926-6599
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5018609Medicaid
NJF01909Medicare UPIN
NJ5018609Medicaid