Provider Demographics
NPI:1093790917
Name:TASHJIAN, DAVID NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NORMAN
Last Name:TASHJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1290 E SPRUCE AVE
Mailing Address - Street 2:#101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3371
Mailing Address - Country:US
Mailing Address - Phone:559-431-2397
Mailing Address - Fax:559-435-2132
Practice Address - Street 1:1290 E SPRUCE AVE
Practice Address - Street 2:#101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3371
Practice Address - Country:US
Practice Address - Phone:559-431-2397
Practice Address - Fax:559-435-2132
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41281207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C412810Medicaid
00C412810Medicare ID - Type Unspecified
CA00C412810Medicaid