Provider Demographics
NPI:1467862920
Name:SHIRVANIAN, VAHEH (MD)
Entity Type:Individual
Prefix:
First Name:VAHEH
Middle Name:
Last Name:SHIRVANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VAHEH
Other - Middle Name:
Other - Last Name:SHIRVANIAN NAMAGERDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4343 WARM SPRINGS RD APT 2014
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-5980
Mailing Address - Country:US
Mailing Address - Phone:818-641-9400
Mailing Address - Fax:
Practice Address - Street 1:1900 10TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3600
Practice Address - Country:US
Practice Address - Phone:706-571-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.36367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program