Provider Demographics
NPI:1326224700
Name:NEW LIFE OB GYN PA
Entity Type:Organization
Organization Name:NEW LIFE OB GYN PA
Other - Org Name:ARAX B NAZARIAN
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARAX
Authorized Official - Middle Name:B
Authorized Official - Last Name:NAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-221-5433
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:STE 330
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3641
Mailing Address - Country:US
Mailing Address - Phone:972-221-5433
Mailing Address - Fax:972-436-3832
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:STE 330
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3641
Practice Address - Country:US
Practice Address - Phone:972-221-5433
Practice Address - Fax:972-436-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8444207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AQ920OtherBCBS
TX1932556801Medicaid
TX5074724OtherAETNA
TX00Y927Medicare PIN
TX5074724OtherAETNA