Provider Demographics
NPI:1821309329
Name:DEMIRCHYAN, KHACHATUR (MD/DO)
Entity Type:Individual
Prefix:DR
First Name:KHACHATUR
Middle Name:
Last Name:DEMIRCHYAN
Suffix:
Gender:M
Credentials:MD/DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 ELMWOOD AVE
Mailing Address - Street 2:APT. 5 G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2655
Mailing Address - Country:US
Mailing Address - Phone:718-258-1950
Mailing Address - Fax:718-258-1950
Practice Address - Street 1:505 ELMWOOD AVE
Practice Address - Street 2:APT. 5 G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2655
Practice Address - Country:US
Practice Address - Phone:718-258-1950
Practice Address - Fax:718-258-1950
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250670208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice