Provider Demographics
NPI:1497073084
Name:VARDANYAN, ARTUR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTUR
Middle Name:
Last Name:VARDANYAN
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 1:800 S CENTRAL AVE
Mailing Address - Street 2:STE 308
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4644
Mailing Address - Country:US
Mailing Address - Phone:818-549-8800
Mailing Address - Fax:818-549-8811
Practice Address - Street 1:800 S CENTRAL AVE
Practice Address - Street 2:STE 308
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4644
Practice Address - Country:US
Practice Address - Phone:818-549-8800
Practice Address - Fax:818-549-8811
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 105695208D00000X
FLME1056952083P0011X
CAA127250208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL148U6OtherBCBS
P00863023OtherRR MEDICARE ATTACHED TO GRP# DQ1103
FL002357800Medicaid
P00863023OtherRR MEDICARE ATTACHED TO GRP# DQ1103