Provider Demographics
NPI:1164473914
Name:AHMADIAN, MANDANA (MD)
Entity type:Individual
Prefix:
First Name:MANDANA
Middle Name:
Last Name:AHMADIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 112TH AVE NE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-289-0374
Mailing Address - Fax:425-453-5150
Practice Address - Street 1:1380 112TH AVE NE
Practice Address - Street 2:SUITE 205
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3759
Practice Address - Country:US
Practice Address - Phone:425-289-0374
Practice Address - Fax:425-453-5150
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044876207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism