Provider Demographics
NPI:1417291998
Name:SARKIS G. AGHAZARIAN M.D.
Entity Type:Organization
Organization Name:SARKIS G. AGHAZARIAN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-452-9240
Mailing Address - Street 1:201 E UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 585
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2829
Mailing Address - Country:US
Mailing Address - Phone:410-554-2935
Mailing Address - Fax:410-261-8055
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:SUITE 585
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-2935
Practice Address - Fax:410-261-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028245208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD377921100Medicaid
MDB66730Medicare UPIN
MD377921100Medicaid