Provider Demographics
NPI:1396222022
Name:JAVARDIAN, ALEX (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:JAVARDIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RIMMA
Other - Middle Name:
Other - Last Name:OGANESOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3241
Mailing Address - Country:US
Mailing Address - Phone:610-327-4200
Mailing Address - Fax:610-327-8160
Practice Address - Street 1:555 SECOND AVE STE 300
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3600
Practice Address - Country:US
Practice Address - Phone:610-454-7750
Practice Address - Fax:610-454-1367
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059804363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical