Provider Demographics
NPI:1205916566
Name:HARATI, YADOLLAH (MD)
Entity type:Individual
Prefix:
First Name:YADOLLAH
Middle Name:
Last Name:HARATI
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:PO BOX 4850
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4850
Mailing Address - Country:US
Mailing Address - Phone:713-798-5995
Mailing Address - Fax:713-798-1898
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1801
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-798-5975
Practice Address - Fax:713-798-5864
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE57782084N0400X, 2084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125021904Medicaid
TX125021904Medicaid
824630Medicare PIN