1316938053 NPI number — MICHAEL KOUYOUMDJIAN D.O.

Table of content: MICHAEL KOUYOUMDJIAN D.O. (NPI 1316938053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316938053 NPI number — MICHAEL KOUYOUMDJIAN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOUYOUMDJIAN
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1316938053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 W ELM ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-567-6967
Provider Business Mailing Address Fax Number:
610-567-6170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1437 DEKALB ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NORRISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19401-3440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-275-7240
Provider Business Practice Location Address Fax Number:
610-275-1381
Provider Enumeration Date:
11/02/2005

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: 207Q00000X , with the licence number:  OS012453 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 34238OS012453 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7904588 . This is a "AUSHC PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P3328720 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30021852 . This is a "KMHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1012103820001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2307449000 . This is a "KEYSTONE HEALTHPLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 231396763 . This is a "DEVON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: K001631770 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0299820 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3618677 . This is a "AUSHC HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 231396763 . This is a "UHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01 01847 . This is a "EVERCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 11460 . This is a "ELDERHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 231396763005 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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