Provider Demographics
NPI:1518939495
Name:TASHJIAN, AUDREY B (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:B
Last Name:TASHJIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 FRANKLIN CORNER RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2526
Mailing Address - Country:US
Mailing Address - Phone:609-896-1400
Mailing Address - Fax:609-896-3986
Practice Address - Street 1:123 FRANKLIN CORNER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2526
Practice Address - Country:US
Practice Address - Phone:609-896-1400
Practice Address - Fax:609-896-3986
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA064278207V00000X
NJ25MA06427800207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG42241Medicare UPIN
NJ620340N6GMedicare PIN