Healthcare Provider Details

I. General information

NPI: 1134113103
Provider Name (Legal Business Name): MAHIN S YAZDANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 SOLOMONS ISLAND RD
HUNTINGTOWN MD
20639-8734
US

IV. Provider business mailing address

PO BOX 370
HUNTINGTOWN MD
20639-0370
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-1695
  • Fax: 410-535-8684
Mailing address:
  • Phone: 410-535-1695
  • Fax: 410-535-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD17774
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: