Provider Demographics
NPI:1821173733
Name:KAZARIAN, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:KAZARIAN
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 1:591 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1901
Mailing Address - Country:US
Mailing Address - Phone:508-852-7522
Mailing Address - Fax:508-854-8271
Practice Address - Street 1:591 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1901
Practice Address - Country:US
Practice Address - Phone:508-852-7522
Practice Address - Fax:508-854-8271
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43471207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7532OtherDAVIS VISION
90510OtherFALLON COMMUNITY HEALTH PLAN
441181899OtherRAILROAD MEDICARE
705171OtherTUFTS HEALTH PLAN
NO1800OtherBLUE SHIELD OF MASSACHUSETTS
15471OtherHARVARD PILGRIM HEALTH CARE
MA2066017Medicaid
441181899OtherRAILROAD MEDICARE
MA2066017Medicaid