Provider Demographics
NPI:1336451798
Name:SADEGHALVAD, AZAR (MD)
Entity Type:Individual
Prefix:
First Name:AZAR
Middle Name:
Last Name:SADEGHALVAD
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 1:1207 N 200TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3213
Mailing Address - Country:US
Mailing Address - Phone:206-542-1517
Mailing Address - Fax:206-542-2317
Practice Address - Street 1:1207 N 200TH ST
Practice Address - Street 2:STE 101
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3213
Practice Address - Country:US
Practice Address - Phone:206-542-1517
Practice Address - Fax:206-542-2317
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60281918261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care