Provider Demographics
NPI:1932508397
Name:NEW AGE RADIOLOGY, PC
Entity Type:Organization
Organization Name:NEW AGE RADIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OGANES
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-213-0060
Mailing Address - Street 1:1050 E 2ND ST
Mailing Address - Street 2:#243
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5313
Mailing Address - Country:US
Mailing Address - Phone:405-213-0060
Mailing Address - Fax:
Practice Address - Street 1:17923 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-8960
Practice Address - Country:US
Practice Address - Phone:405-213-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK268542085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty