Provider Demographics
NPI:1164800827
Name:KOSTANYAN, TIGRAN (MD)
Entity Type:Individual
Prefix:
First Name:TIGRAN
Middle Name:
Last Name:KOSTANYAN
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 1:2110 E FLAMINGO RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5193
Mailing Address - Country:US
Mailing Address - Phone:702-932-4257
Mailing Address - Fax:702-734-0419
Practice Address - Street 1:2110 E FLAMINGO RD STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5193
Practice Address - Country:US
Practice Address - Phone:702-932-4257
Practice Address - Fax:702-734-0419
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19705207W00000X
PAMD467621207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology