Provider Demographics
NPI:1619993995
Name:ESKANDARI, FARIDEH (MD)
Entity Type:Individual
Prefix:
First Name:FARIDEH
Middle Name:
Last Name:ESKANDARI
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 1:12303 NE 130TH LN
Mailing Address - Street 2:SUITE 405
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3099
Mailing Address - Country:US
Mailing Address - Phone:425-242-5412
Mailing Address - Fax:425-242-5429
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:SUITE 405
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3099
Practice Address - Country:US
Practice Address - Phone:425-242-5412
Practice Address - Fax:425-242-5429
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00048717207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8502262Medicaid
WAG8894198OtherTYPE 1 PTAN
WA8502262Medicaid