Provider Demographics
NPI:1619280013
Name:YAZDANFAR, RAMIN SHAHRAM (MD)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:SHAHRAM
Last Name:YAZDANFAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 W CHESTER PIKE STE 160
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2336
Mailing Address - Country:US
Mailing Address - Phone:484-337-1632
Mailing Address - Fax:
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-6421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102844341Medicaid
PA30161184OtherAMERIHEALTH CARITAS PA - THFP
PA420539OtherUPMC
PA2898520OtherHIGHMARK BLUE SHIELD
PA30161185OtherAMERIHEALTH CARITAS PA - WMG
PA2898520OtherHIGHMARK BLUE SHIELD
PA102844341Medicaid
PA298686FLTMedicare PIN