Provider Demographics
NPI:1013936400
Name:AVETIAN, GARO CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:GARO
Middle Name:CHARLES
Last Name:AVETIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-926-9022
Mailing Address - Fax:215-226-8286
Practice Address - Street 1:1919 GREENTREE RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1115
Practice Address - Country:US
Practice Address - Phone:856-761-8100
Practice Address - Fax:856-761-8107
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007148-L207R00000X
NJ25MB08454100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1013936400OtherNPI
PACD4829OtherRAILROAD MEDICARE
PA597586OtherMEDICARE GROUP
PA597586Medicare PIN
NJ1013936400OtherNPI
NJ597586PMZMedicare PIN