Provider Demographics
NPI:1801051321
Name:IZADI, AZADE (MD)
Entity type:Individual
Prefix:DR
First Name:AZADE
Middle Name:
Last Name:IZADI
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 1:139A CHARLES ST
Mailing Address - Street 2:# 220
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3252
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:139A CHARLES ST
Practice Address - Street 2:#220
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3252
Practice Address - Country:US
Practice Address - Phone:508-327-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2023-06-01
Deactivation Date:2019-09-03
Deactivation Code:
Reactivation Date:2019-12-23
Provider Licenses
StateLicense IDTaxonomies
WAMD00039210207R00000X
MA202800208M00000X
CAA71801208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine