Provider Demographics
NPI:1174647192
Name:MARKARIAN, MARK KHAJAG (MD, MSPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:KHAJAG
Last Name:MARKARIAN
Suffix:
Gender:M
Credentials:MD, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14847 HAYWARD ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2048
Mailing Address - Country:US
Mailing Address - Phone:706-495-7886
Mailing Address - Fax:
Practice Address - Street 1:25 WALNUT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2152
Practice Address - Country:US
Practice Address - Phone:781-431-0002
Practice Address - Fax:781-237-2022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2554222086S0122X
CA1305232086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLL1592OtherMEDICAL LICENSE
NVASO2532199092OtherDEA CERTIFICATE