Provider Demographics
NPI:1861998874
Name:PIVAZYAN, GNEL (MD)
Entity type:Individual
Prefix:
First Name:GNEL
Middle Name:
Last Name:PIVAZYAN
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 1:3800 RESERVOIR RD NW # 7PHC
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-4972
Mailing Address - Fax:202-444-7333
Practice Address - Street 1:259 E ERIE ST STE 1450
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3947
Practice Address - Country:US
Practice Address - Phone:312-695-7746
Practice Address - Fax:312-694-6387
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036175787207T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program