Provider Demographics
NPI:1487838512
Name:GURDJIAN, EDWIN S (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:S
Last Name:GURDJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13920 ARBUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16438-9007
Mailing Address - Country:US
Mailing Address - Phone:814-438-2050
Mailing Address - Fax:954-208-2704
Practice Address - Street 1:13920 ARBUCKLE RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438-9007
Practice Address - Country:US
Practice Address - Phone:814-438-2050
Practice Address - Fax:954-208-2704
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD011688E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28165Medicare UPIN