Provider Demographics
NPI:1417052366
Name:ANTON A. MINASSIAN PAIN MEDICINE & REHABILITATION SVCS
Entity Type:Organization
Organization Name:ANTON A. MINASSIAN PAIN MEDICINE & REHABILITATION SVCS
Other - Org Name:PAIN MEDICINE & REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:ANTRANIK
Authorized Official - Last Name:MINASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-654-4948
Mailing Address - Street 1:7984 OLD GEORGETOWN RD
Mailing Address - Street 2:SUITE 7C
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2448
Mailing Address - Country:US
Mailing Address - Phone:301-654-4948
Mailing Address - Fax:301-654-0770
Practice Address - Street 1:7984 OLD GEORGETOWN RD
Practice Address - Street 2:SUITE 7C
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2448
Practice Address - Country:US
Practice Address - Phone:301-654-4948
Practice Address - Fax:301-654-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051046208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02422Medicare PIN