Provider Demographics
NPI:1649291907
Name:NAZEMI, TANYA M (MD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:NAZEMI
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 1:1101 MADISON ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-4308
Mailing Address - Country:US
Mailing Address - Phone:206-386-6266
Mailing Address - Fax:206-386-2844
Practice Address - Street 1:1101 MADISON ST STE 1400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-4308
Practice Address - Country:US
Practice Address - Phone:206-386-6266
Practice Address - Fax:206-386-2844
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046388208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039595OtherL&I
WA1649291907Medicaid
WA4941NAOtherBLUE SHIELD
WA8468431Medicaid
WA8861991Medicare PIN