Provider Demographics
NPI:1922085844
Name:BASTADJIAN-YESSAYAN, SYLVIE (MD)
Entity Type:Individual
Prefix:
First Name:SYLVIE
Middle Name:
Last Name:BASTADJIAN-YESSAYAN
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5427 NC HIGHWAY 49 S
Practice Address - Street 2:STE 102
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7408
Practice Address - Country:US
Practice Address - Phone:704-454-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400716207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC118608OtherWELLPATH
NC1282TOtherBCBS
NC5024508OtherAETNA
NC566000156OtherTAX ID
NC1282TOtherBCBSNC
NC43727OtherPARTNERS MEDICARE CHOICE
NC110232592OtherRAILROAD MEDICARE ID
NCA7882OtherMEDCOST
NC208776473OtherTAX ID
NC1394741OtherCIGNA HEALTHCARE
NC891282TMedicaid
NC232009OtherMEDICARE OTHER
NC1424558OtherUNITED HEALTHCARE
NC296989OtherMAMSI
NC43727OtherPARTNERS MEDICARE CHOICE
NC232009OtherMEDICARE OTHER
NC891282TMedicaid