Provider Demographics
NPI:1770921470
Name:ESLAAMIZAAD, YASAMAN (MD)
Entity type:Individual
Prefix:MS
First Name:YASAMAN
Middle Name:
Last Name:ESLAAMIZAAD
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 1:150-55TH STREET STATION 3-04
Mailing Address - Street 2:LUTHERAN MEDICAL CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:718-630-7000
Mailing Address - Fax:718-210-5319
Practice Address - Street 1:801 MISSION ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6217
Practice Address - Country:US
Practice Address - Phone:503-580-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2019-09-18
Deactivation Date:2014-04-03
Deactivation Code:
Reactivation Date:2014-06-18
Provider Licenses
StateLicense IDTaxonomies
ORMD191265207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease