Provider Demographics
NPI:1861671778
Name:ARAM MARDIAN, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ARAM MARDIAN, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OWNER, ALL TITLES
Authorized Official - Prefix:
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-841-7600
Mailing Address - Street 1:2520 MILVIA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2629
Mailing Address - Country:US
Mailing Address - Phone:510-841-7600
Mailing Address - Fax:
Practice Address - Street 1:2520 MILVIA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2629
Practice Address - Country:US
Practice Address - Phone:510-841-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952366734OtherPERSONAL NPI