Provider Demographics
NPI:1588802615
Name:DERDERIAN, CHRISTOPHER ARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ARMEN
Last Name:DERDERIAN
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 1:4131 N CENTRAL EXPY STE 448
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2188
Mailing Address - Country:US
Mailing Address - Phone:214-827-8407
Mailing Address - Fax:214-827-5001
Practice Address - Street 1:560 1ST AVE
Practice Address - Street 2:TCH-169
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5834
Practice Address - Fax:212-263-5400
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0035208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP0035OtherMEDICAL LICENSE