Provider Demographics
NPI:1609893254
Name:PALANDJIAN, KHATCHADOUR BEDROS (MD)
Entity Type:Individual
Prefix:
First Name:KHATCHADOUR
Middle Name:BEDROS
Last Name:PALANDJIAN
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 1:202 CAROL RD
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-1402
Mailing Address - Country:US
Mailing Address - Phone:570-383-3430
Mailing Address - Fax:
Practice Address - Street 1:202 CAROL RD
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-1402
Practice Address - Country:US
Practice Address - Phone:570-383-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035887-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC33094Medicare UPIN
PAPA187945Medicare ID - Type Unspecified