Provider Demographics
NPI:1891361671
Name:DERIAN, ANNA ANUSH (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ANUSH
Last Name:DERIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-1927
Mailing Address - Country:US
Mailing Address - Phone:570-645-1950
Mailing Address - Fax:570-645-1955
Practice Address - Street 1:34 S RAILROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1927
Practice Address - Country:US
Practice Address - Phone:570-645-1950
Practice Address - Fax:570-645-1955
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program