Provider Demographics
NPI:1629752340
Name:SEDRAKYAN, SURIK (MD)
Entity Type:Individual
Prefix:MR
First Name:SURIK
Middle Name:
Last Name:SEDRAKYAN
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 1:736 CAMBRIDGE STREET
Mailing Address - Street 2:CBR BUILDING 1ST FLOOR-RM115
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-789-2386
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE STREET ST. ELIZABETH'S MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-289-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2024-03-26
Deactivation Date:2024-01-17
Deactivation Code:
Reactivation Date:2024-03-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program