Provider Demographics
NPI:1073677498
Name:KHACHIYAN, NONNA (PA-C)
Entity Type:Individual
Prefix:
First Name:NONNA
Middle Name:
Last Name:KHACHIYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 PRESIDENT AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5923
Mailing Address - Country:US
Mailing Address - Phone:401-751-7546
Mailing Address - Fax:401-751-6888
Practice Address - Street 1:1030 PRESIDENT AVE STE 306
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:401-751-7546
Practice Address - Fax:401-751-6888
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00469829Medicare PIN
MAAP280201Medicare PIN