Provider Demographics
NPI:1245205897
Name:SADRI, AZRA (MD)
Entity Type:Individual
Prefix:
First Name:AZRA
Middle Name:
Last Name:SADRI
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 1:1940 116TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3097
Mailing Address - Country:US
Mailing Address - Phone:425-453-6838
Mailing Address - Fax:425-456-0106
Practice Address - Street 1:1940 116TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3097
Practice Address - Country:US
Practice Address - Phone:425-453-6838
Practice Address - Fax:425-456-0106
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8144859Medicaid
WAF49364Medicare UPIN
WA8144859Medicaid