Provider Demographics
NPI:1467546911
Name:NIKOGOSIAN, ARMEN E (MD)
Entity Type:Individual
Prefix:
First Name:ARMEN
Middle Name:E
Last Name:NIKOGOSIAN
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 1:5380 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1899
Mailing Address - Country:US
Mailing Address - Phone:702-362-9930
Mailing Address - Fax:702-362-9954
Practice Address - Street 1:5380 S RAINBOW BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1899
Practice Address - Country:US
Practice Address - Phone:702-362-9930
Practice Address - Fax:702-362-9954
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10614174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500884Medicaid
H90958Medicare UPIN
NVV38155Medicare ID - Type Unspecified