Provider Demographics
NPI:1144222480
Name:DEMIRJIAN, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:DEMIRJIAN
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 1:3732 BLOSSOM HEATH RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1109
Mailing Address - Country:US
Mailing Address - Phone:937-298-3800
Mailing Address - Fax:937-296-0272
Practice Address - Street 1:7034 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4237
Practice Address - Country:US
Practice Address - Phone:937-298-3800
Practice Address - Fax:937-296-0272
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048624D208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0500446OtherUNITED HEALTHCARE
OH2086574OtherAETNA
OH000000037042OtherANTHEM
OH0518461Medicaid
OHD48624OtherHUMANA
A80569Medicare UPIN
OH2086574OtherAETNA
OH0518461Medicaid