Provider Demographics
NPI:1154458628
Name:TATEVOSYANTS, ALEXANDER (DA)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:TATEVOSYANTS
Suffix:
Gender:M
Credentials:DA
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:TATEVIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DA
Mailing Address - Street 1:141 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-1032
Mailing Address - Country:US
Mailing Address - Phone:401-738-9355
Mailing Address - Fax:401-679-0038
Practice Address - Street 1:141 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-1032
Practice Address - Country:US
Practice Address - Phone:401-738-9355
Practice Address - Fax:401-679-0038
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI64171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist