Provider Demographics
NPI:1326381468
Name:KELESHIAN, HAGOP JACK (DO)
Entity Type:Individual
Prefix:DR
First Name:HAGOP
Middle Name:JACK
Last Name:KELESHIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:HAGOP
Other - Last Name:KELESHIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:201 INDEPENDENCE STE 225
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39710-5300
Mailing Address - Country:US
Mailing Address - Phone:626-434-2237
Mailing Address - Fax:
Practice Address - Street 1:201 INDEPENDENCE STE 225
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39710-5300
Practice Address - Country:US
Practice Address - Phone:626-434-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25027207Q00000X
ARE-14904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine