1134113103 NPI number — MRS. MAHIN S YAZDANI M.D.

Table of content: MRS. MAHIN S YAZDANI M.D. (NPI 1134113103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134113103 NPI number — MRS. MAHIN S YAZDANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAZDANI
Provider First Name:
MAHIN
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134113103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20639-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-535-1695
Provider Business Mailing Address Fax Number:
410-535-8684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2555 SOLOMONS ISLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20639-8734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-535-1695
Provider Business Practice Location Address Fax Number:
410-535-8684
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  D17774 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 220291300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 406112094 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76450002 . This is a "BC/BS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 810924 . This is a "MDIPA, OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com