1487846804 NPI number — DEMIRJIAN NEUROLOGY & PAIN MANAGEMENT, INC.

Table of content: (NPI 1487846804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487846804 NPI number — DEMIRJIAN NEUROLOGY & PAIN MANAGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEMIRJIAN NEUROLOGY & PAIN MANAGEMENT, INC.
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:
Provider Other Organization Name Type Code:
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:
1487846804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3732 BLOSSOM HEATH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45419-1109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-298-3800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7034 CORPORATE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45459-4237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-298-3800
Provider Business Practice Location Address Fax Number:
937-296-0272
Provider Enumeration Date:
08/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEMIRJIAN
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-298-3800

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  35048624D , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0500446 . This is a "UNITED HEATHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 383369570-00 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 383369570006 . This is a "MEDICAL MUTUAL OF OHIO" identifier . This identifiers is of the category "OTHER".
  • Identifier: D48624 . This is a "HUMANA CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000037042 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0518461 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383369570013 . This is a "MEDICAL MUTUAL OF OHIO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2086574 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".