Provider Demographics
NPI:1578661955
Name:VARUJAN AREK KELEDJIAN, MD, INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VARUJAN AREK KELEDJIAN, MD, INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VARUJAN
Authorized Official - Middle Name:AREK
Authorized Official - Last Name:KELEDJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-754-8710
Mailing Address - Street 1:3903 LONE TREE WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6269
Mailing Address - Country:US
Mailing Address - Phone:925-754-8710
Mailing Address - Fax:925-754-0765
Practice Address - Street 1:3903 LONE TREE WAY STE 205
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6269
Practice Address - Country:US
Practice Address - Phone:925-754-8710
Practice Address - Fax:925-754-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46647207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29207ZMedicare ID - Type Unspecified
CAD88683Medicare UPIN