1821173733 NPI number — EDWARD KAZARIAN M.D.

Table of content: EDWARD KAZARIAN M.D. (NPI 1821173733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821173733 NPI number — EDWARD KAZARIAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAZARIAN
Provider First Name:
EDWARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1821173733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
591 LINCOLN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01605-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-852-7522
Provider Business Mailing Address Fax Number:
508-854-8271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
591 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-852-7522
Provider Business Practice Location Address Fax Number:
508-854-8271
Provider Enumeration Date:
10/26/2006

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: 207W00000X , with the licence number:  43471 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7532 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90510 . This is a "FALLON COMMUNITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 441181899 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 705171 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: NO1800 . This is a "BLUE SHIELD OF MASSACHUSETTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15471 . This is a "HARVARD PILGRIM HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2066017 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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