Provider Demographics
NPI:1447246459
Name:RAZA, SUGHRA (MD)
Entity type:Individual
Prefix:
First Name:SUGHRA
Middle Name:
Last Name:RAZA
Suffix:
Gender:F
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:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-3850
Practice Address - Fax:508-334-6490
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH232012085R0202X
MA738562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3082237Medicaid
MAE95640BWHTOtherHARVARD PILGRIM
MA73856OtherTUFTS HEALTH CARE
MAJ11473OtherBLUE CROSS BLUE SHIELD
MA3082237Medicaid
MA73856OtherTUFTS HEALTH CARE