1417052366 NPI number — ANTON A. MINASSIAN PAIN MEDICINE & REHABILITATION SVCS

Table of content: (NPI 1417052366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417052366 NPI number — ANTON A. MINASSIAN PAIN MEDICINE & REHABILITATION SVCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTON A. MINASSIAN PAIN MEDICINE & REHABILITATION SVCS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PAIN MEDICINE & REHAB
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417052366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7984 OLD GEORGETOWN RD
Provider Second Line Business Mailing Address:
SUITE 7C
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814-2448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-654-4948
Provider Business Mailing Address Fax Number:
301-654-0770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7984 OLD GEORGETOWN RD
Provider Second Line Business Practice Location Address:
SUITE 7C
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20814-2448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-654-4948
Provider Business Practice Location Address Fax Number:
301-654-0770
Provider Enumeration Date:
09/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MINASSIAN
Authorized Official First Name:
ANTON
Authorized Official Middle Name:
ANTRANIK
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
301-654-4948

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  D0051046 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: D0051046 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)