Provider Demographics
NPI:1497809925
Name:M NAZARIAN MD ASSOC
Entity Type:Organization
Organization Name:M NAZARIAN MD ASSOC
Other - Org Name:M NAZARIAN MD PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUCHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-336-4454
Mailing Address - Street 1:757 8TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2522
Mailing Address - Country:US
Mailing Address - Phone:817-336-4454
Mailing Address - Fax:817-336-4440
Practice Address - Street 1:757 8TH AVE
Practice Address - Street 2:M NAZARIAN MD ASSOC
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2522
Practice Address - Country:US
Practice Address - Phone:817-336-4454
Practice Address - Fax:817-336-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9248208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4584370009OtherCIGNA
0613110OtherAETNA
4584370009OtherCIGNA
0613110OtherAETNA