Provider Demographics
NPI:1760777635
Name:TCHEKMEDYIAN, VATCHE (MD)
Entity Type:Individual
Prefix:DR
First Name:VATCHE
Middle Name:
Last Name:TCHEKMEDYIAN
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 1:95 PARK DR
Mailing Address - Street 2:APT. #14
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5255
Mailing Address - Country:US
Mailing Address - Phone:917-628-5324
Mailing Address - Fax:
Practice Address - Street 1:265 WESTERN AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2458
Practice Address - Country:US
Practice Address - Phone:207-661-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-18
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22978207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology