1043590474 NPI number — ALEXANDER ASATURYAN CNP

Table of content: ALEXANDER ASATURYAN CNP (NPI 1043590474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043590474 NPI number — ALEXANDER ASATURYAN CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASATURYAN
Provider First Name:
ALEXANDER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
M

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:
1043590474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8055 MAYFIELD RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERLAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44026-2447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-232-4455
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88 CENTER RD STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44146-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-232-4455
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  APRN.CNP.025628 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN.CNP.025628 , 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)