Provider Demographics
NPI:1043260748
Name:KLANIAN, JR., CHARLES SARKIS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:SARKIS
Last Name:KLANIAN, JR.
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:11629 WOOD BLUFF LOOP
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-2405
Mailing Address - Country:US
Mailing Address - Phone:804-675-5403
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5403
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1004758OtherPA CERTIFICATION NUMBER