Provider Demographics
NPI:1134130735
Name:YEGHIAZARIANS, VARTAN (MD)
Entity Type:Individual
Prefix:
First Name:VARTAN
Middle Name:
Last Name:YEGHIAZARIANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5821
Mailing Address - Country:US
Mailing Address - Phone:978-685-5627
Mailing Address - Fax:978-688-3987
Practice Address - Street 1:411 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5821
Practice Address - Country:US
Practice Address - Phone:978-685-5627
Practice Address - Fax:978-688-3987
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150516207R00000X
NH9895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ17287OtherBCBS
MA3179371Medicaid
NHRE4338Medicare ID - Type Unspecified
MA3179371Medicaid
G39434Medicare UPIN