Provider Demographics
NPI:1346504628
Name:GEVORGYAN, ALEXANDER G (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:G
Last Name:GEVORGYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:GEVORGYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1332 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3349
Mailing Address - Country:US
Mailing Address - Phone:818-649-9232
Mailing Address - Fax:818-696-0922
Practice Address - Street 1:1332 S GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3349
Practice Address - Country:US
Practice Address - Phone:818-649-9232
Practice Address - Fax:818-696-0922
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1331542084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology