Provider Demographics
NPI:1679778336
Name:M & K YAZDANI P A
Entity type:Organization
Organization Name:M & K YAZDANI P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIOUMARCE
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-535-1695
Mailing Address - Street 1:2555 SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-8734
Mailing Address - Country:US
Mailing Address - Phone:410-535-1695
Mailing Address - Fax:410-535-8684
Practice Address - Street 1:2555 SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639
Practice Address - Country:US
Practice Address - Phone:410-535-1695
Practice Address - Fax:410-535-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE4776OtherMEDICARE RAILROAD
MDD76335Medicare UPIN
DE4776OtherMEDICARE RAILROAD
MD016LMedicare PIN