Provider Demographics
NPI:1750598470
Name:IZADI, REZA (D,O)
Entity type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:IZADI
Suffix:
Gender:M
Credentials:D,O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3374
Mailing Address - Country:US
Mailing Address - Phone:914-582-5909
Mailing Address - Fax:888-394-0177
Practice Address - Street 1:1150 VARNUM ST NE
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2104
Practice Address - Country:US
Practice Address - Phone:914-582-5909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244086207L00000X
TXN1689207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02907380Medicaid