Provider Demographics
NPI:1275534729
Name:MEDZOYAN, KAREN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:A
Last Name:MEDZOYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N. 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-5040
Mailing Address - Country:US
Mailing Address - Phone:717-273-1710
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:618 CUMBERLAND STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5232
Practice Address - Country:US
Practice Address - Phone:717-274-2741
Practice Address - Fax:717-274-5405
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD074448-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019523140006Medicaid
PA0019523140006Medicaid
PA069695Medicare ID - Type Unspecified