Provider Demographics
NPI:1548262991
Name:YADEGARI-LEWIS, NASRENE R (MD)
Entity type:Individual
Prefix:DR
First Name:NASRENE
Middle Name:R
Last Name:YADEGARI-LEWIS
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 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:3757 CARMAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303
Practice Address - Country:US
Practice Address - Phone:518-355-7063
Practice Address - Fax:518-357-0646
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225932208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02503139Medicaid
NY108959OtherGHI HMO
NY00040470005OtherBSNENY
NY10076388OtherCDPHP
NY388457OtherMVP
NY070216000077OtherFIDELIS
NY397AL2OtherEMPIRE BC
NY7886635OtherAETNA
NY200421OtherSENIOR WHOLE HEALTH
NY00040470005OtherBSNENY
NY10076388OtherCDPHP