Provider Demographics
NPI:1639349319
Name:HOVIK TAYMOORIAN DO PA
Entity Type:Organization
Organization Name:HOVIK TAYMOORIAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:TAYMOORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-768-6702
Mailing Address - Street 1:8028 RITCHIE HWY
Mailing Address - Street 2:SUITE 126
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1075
Mailing Address - Country:US
Mailing Address - Phone:410-768-6702
Mailing Address - Fax:410-768-6704
Practice Address - Street 1:8028 RITCHIE HWY
Practice Address - Street 2:SUITE 126
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1075
Practice Address - Country:US
Practice Address - Phone:410-768-6702
Practice Address - Fax:410-768-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0054974207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018202800Medicaid
MD018202800Medicaid
MD093M979EMedicare PIN