Provider Demographics
NPI:1508126624
Name:OGANISYAN, ZHORA ZHORAVICH (MD)
Entity Type:Individual
Prefix:
First Name:ZHORA
Middle Name:ZHORAVICH
Last Name:OGANISYAN
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 1:7005 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2509
Mailing Address - Country:US
Mailing Address - Phone:941-465-4800
Mailing Address - Fax:877-446-1404
Practice Address - Street 1:7005 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2509
Practice Address - Country:US
Practice Address - Phone:941-465-4800
Practice Address - Fax:877-446-1404
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1326232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2199552Medicaid