Provider Demographics
NPI:1225288582
Name:AGVANYAN, EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:
Last Name:AGVANYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:544 N GLENDALE AVE
Mailing Address - Street 2:VERDUGO HILLS MEDICAL ASSOCIATES
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3311
Mailing Address - Country:US
Mailing Address - Phone:818-241-4331
Mailing Address - Fax:818-241-2253
Practice Address - Street 1:544 N GLENDALE AVE
Practice Address - Street 2:VERDUGO HILLS MEDICAL ASSOCIATES
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3311
Practice Address - Country:US
Practice Address - Phone:818-241-4331
Practice Address - Fax:818-241-2253
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA105325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine