MEDICARE: DR. NASRENE R YADEGARI-LEWIS M.D.

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	208000000X	Pediatrics Physician	225932	NY
2	207R00000X	Internal Medicine Physician	225932	NY

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
2	108959	OTHER	NY	GHI HMO
3	00040470005	OTHER	NY	BSNENY
4	10076388	OTHER	NY	CDPHP
5	388457	OTHER	NY	MVP
6	070216000077	OTHER	NY	FIDELIS
7	397AL2	OTHER	NY	EMPIRE BC
8	7886635	OTHER	NY	AETNA
9	200421	OTHER	NY	SENIOR WHOLE HEALTH

General Provider Information

NPI Number	:	1548262991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NASRENE R YADEGARI-LEWIS M.D.

Provider Business Mailing Address
First Line	:	711 TROY SCHENECTADY RD STE 203
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2461
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:	518-782-3799

Provider Business Practice Location Address
First Line	:	3757 CARMAN RD
Second Line	:	SUITE 100
City	:	SCHENECTADY
State	:	NY
Zip	:	12303
Country	:	US
Telephone Number	:	518-355-7063
Fax Number	:	518-357-0646

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	01/31/2018

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