Provider Demographics
NPI:1376585091
Name:OVANESSIAN, SIMON AWADIS (MD)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:AWADIS
Last Name:OVANESSIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-889-6147
Mailing Address - Fax:603-883-1568
Practice Address - Street 1:7 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-889-6147
Practice Address - Fax:603-883-1568
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2322612084P0800X
CT0420792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001420794Medicaid
CTP3624013OtherOXFORD
CT810698118OtherPHCS
CO343759OtherMANAGED HEALTH NETWORK
CT537053OtherVALUE OPTIONS
CT1420794Medicaid
CT15-54607OtherUNITED BEHAVIORAL HEALTH
CT260004235Medicare ID - Type Unspecified
CTI01590Medicare UPIN
CT810698118OtherPHCS