MEDICARE: MOHAMMAD-ALI YAZDANI ABYANEH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207N00000X	Dermatology Physician	299230	NY
3	207N00000X	Dermatology Physician	0101286129	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508252784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD-ALI YAZDANI ABYANEH

Provider Business Mailing Address
First Line	:	1729 BURRSTONE RD
Second Line	:
City	:	NEW HARTFORD
State	:	NY
Zip	:	13413-1001
Country	:	US
Telephone Number	:	315-798-1832
Fax Number	:	315-798-1432

Provider Business Practice Location Address
First Line	:	2296 OPITZ BLVD STE 250
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3345
Country	:	US
Telephone Number	:	703-844-4267
Fax Number	:	703-982-7238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	03/17/2026

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