Provider Demographics
NPI:1184772048
Name:VARDANIAN, FLORA ABRAHAMIAN (MD)
Entity type:Individual
Prefix:
First Name:FLORA
Middle Name:ABRAHAMIAN
Last Name:VARDANIAN
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 1:94 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1740
Mailing Address - Country:US
Mailing Address - Phone:626-792-4171
Mailing Address - Fax:626-792-2328
Practice Address - Street 1:94 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1740
Practice Address - Country:US
Practice Address - Phone:626-792-4171
Practice Address - Fax:626-792-2328
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261242207K00000X
CAA85631207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A856310Medicaid
I49579Medicare UPIN