Provider Demographics
NPI:1881669315
Name:RAZ, AMY BETH (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:RAZ
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 1:5617 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-3611
Mailing Address - Country:US
Mailing Address - Phone:980-326-2700
Mailing Address - Fax:980-326-4150
Practice Address - Street 1:5617 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-3611
Practice Address - Country:US
Practice Address - Phone:980-326-2700
Practice Address - Fax:980-326-4150
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-00909207R00000X
NY215814207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02181322Medicaid
NY02181322Medicaid
NYA400114937Medicare PIN
NYH48369Medicare UPIN