Provider Demographics
NPI:1205890746
Name:GEORGIAN, FREDERICK P (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:P
Last Name:GEORGIAN
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 1:5 NEPONSET ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-595-2300
Mailing Address - Fax:508-853-5226
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-595-2300
Practice Address - Fax:508-853-5226
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110065177AMedicaid
042472266OtherPRIVATE HEALTHCARE SYSTEM
9900859OtherFALLON COMMUNITY HEALTH P
J04011OtherBLUE SHIELD INDEMNITY
110162848OtherRAILROAD MEDICARE
7039340OtherCIGNA HEALTH PLAN
J04011OtherBLUE CARE ELECT
J04011OtherMEDICARE B
042472266OtherHEALTHCARE VALUE MGMT
MA6185592Medicaid
917730OtherFIRST HEALTH
J04011OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
26853OtherHEALTHY START
5886688OtherAETNA US HEALTHCARE
AA1204OtherHARVARD PILGRIM HEALTHCAR
0401727OtherEVERCARE
784137OtherMVP HEALTH CARE
042472266OtherONE HEALTH PLAN
110162848OtherRAILROAD MEDICARE