Provider Demographics
NPI:1427010776
Name:SEHAPAYAK, GEORGINA KERLAKIAN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:KERLAKIAN
Last Name:SEHAPAYAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 W ROSEDALE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7400
Mailing Address - Country:US
Mailing Address - Phone:817-820-0141
Mailing Address - Fax:817-820-0145
Practice Address - Street 1:1650 W ROSEDALE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-820-0141
Practice Address - Fax:817-820-0145
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8427207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135480501Medicaid
TXB26323Medicare UPIN
TX135480501Medicaid