Provider Demographics
NPI:1730137670
Name:BAJAKIAN, RICHARD L (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:BAJAKIAN
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 1:1700 W WOOLBRIGHT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6346
Mailing Address - Country:US
Mailing Address - Phone:561-732-3909
Mailing Address - Fax:561-732-0166
Practice Address - Street 1:1700 W WOOLBRIGHT RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6346
Practice Address - Country:US
Practice Address - Phone:561-732-3909
Practice Address - Fax:561-732-0166
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57520174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE43737Medicare UPIN
FL12500ZMedicare ID - Type Unspecified