Provider Demographics
NPI:1508831678
Name:KELEDJIAN, VARUJAN AREK (MD)
Entity Type:Individual
Prefix:DR
First Name:VARUJAN
Middle Name:AREK
Last Name:KELEDJIAN
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 1:3903 LONE TREE WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6249
Mailing Address - Country:US
Mailing Address - Phone:925-754-8710
Mailing Address - Fax:925-754-0765
Practice Address - Street 1:3903 LONE TREE WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6249
Practice Address - Country:US
Practice Address - Phone:925-754-8710
Practice Address - Fax:925-754-0765
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA046647207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD88683Medicare UPIN
CA00A466470Medicare ID - Type Unspecified