Provider Demographics
NPI:1417977489
Name:TABECHIAN, DARREN A (MD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:A
Last Name:TABECHIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 RED CREEK DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4273
Mailing Address - Country:US
Mailing Address - Phone:585-486-0901
Mailing Address - Fax:585-340-5399
Practice Address - Street 1:400 RED CREEK DR
Practice Address - Street 2:SUITE 240
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4273
Practice Address - Country:US
Practice Address - Phone:585-486-0901
Practice Address - Fax:585-340-5399
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226298207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD4320Medicare PIN