Provider Demographics
NPI:1679548507
Name:HOVAGUIMIAN, HAGOP (MD)
Entity Type:Individual
Prefix:
First Name:HAGOP
Middle Name:
Last Name:HOVAGUIMIAN
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 1:9155 SW BARNES RD
Mailing Address - Street 2:STE 240
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6625
Mailing Address - Country:US
Mailing Address - Phone:503-296-4027
Mailing Address - Fax:503-216-2488
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:STE 240
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-296-4027
Practice Address - Fax:503-216-2488
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14223208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALMD2230ROtherALASKA WELFARE
WA8186452Medicaid
CA186452Medicaid
E20957Medicare UPIN
ORR117984Medicare PIN