Provider Demographics
NPI:1326037508
Name:SARKISYAN, ALLA R (MD)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:R
Last Name:SARKISYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:200 GROTON ROAD
Mailing Address - Street 2:NASHOBA VALLEY HEALTHCARE GROUP
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432
Mailing Address - Country:US
Mailing Address - Phone:978-784-9000
Mailing Address - Fax:
Practice Address - Street 1:497 MAIN STREET
Practice Address - Street 2:4B
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450
Practice Address - Country:US
Practice Address - Phone:978-449-0471
Practice Address - Fax:978-784-9982
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2084666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMX7048OtherPTAN
MAMX7054OtherPTAN 41
MA0142051Medicaid
MAMX7054OtherPTAN 41
H44625Medicare UPIN