Provider Demographics
NPI:1437149226
Name:ZEROOGIAN, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:ZEROOGIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S RAYMOND AVE UNIT 240
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3283
Mailing Address - Country:US
Mailing Address - Phone:626-449-9920
Mailing Address - Fax:626-578-7366
Practice Address - Street 1:630 S RAYMOND AVE UNIT 240
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3283
Practice Address - Country:US
Practice Address - Phone:626-449-9920
Practice Address - Fax:626-578-7366
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033771207RG0100X
MA73813207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA073813OtherTUFTS HEALTH PLAN
MA3127125Medicaid
CTJ14535OtherBLUE CROSS BLUE SHIELD MA
MA100000307OtherBLUE CROSS BLUE SHIELD CT
MAJ14535Medicare ID - Type Unspecified
CTJ14535OtherBLUE CROSS BLUE SHIELD MA
MA073813OtherTUFTS HEALTH PLAN