Provider Demographics
NPI:1144263054
Name:SADR, IRAN (MD)
Entity type:Individual
Prefix:DR
First Name:IRAN
Middle Name:
Last Name:SADR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:M
Other - Last Name:SADR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
Practice Address - Street 1:800 BRADBURY DR SE STE 116
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4310
Practice Address - Country:US
Practice Address - Phone:505-272-1476
Practice Address - Fax:505-272-1212
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2021-09482080P0202X
MDD69498208M00000X, 208M00000X
MDD694882080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE6981Medicare ID - Type Unspecified
NHH32883Medicare UPIN
NH30010349Medicaid