Provider Demographics
NPI:1386674299
Name:FERESHETIAN, ARAM V (MD)
Entity Type:Individual
Prefix:
First Name:ARAM
Middle Name:V
Last Name:FERESHETIAN
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 1:1350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1628
Mailing Address - Country:US
Mailing Address - Phone:413-495-1122
Mailing Address - Fax:413-827-7407
Practice Address - Street 1:1350 MAIN ST
Practice Address - Street 2:1007
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1628
Practice Address - Country:US
Practice Address - Phone:413-495-1100
Practice Address - Fax:413-827-7407
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0747072085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3080480Medicaid
CT003079937Medicaid
MAJ11357Medicare ID - Type Unspecified
MA3080480Medicaid