Provider Demographics
NPI:1376585091
Name:OVANESSIAN, SIMON AWADIS (MD)
Entity type:Individual
Prefix:MR
First Name:SIMON
Middle Name:AWADIS
Last Name:OVANESSIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 FRIBERG PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3900
Mailing Address - Country:US
Mailing Address - Phone:508-329-6300
Mailing Address - Fax:508-329-6088
Practice Address - Street 1:300 FRIBERG PKWY
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3900
Practice Address - Country:US
Practice Address - Phone:508-329-6300
Practice Address - Fax:508-329-6088
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2322612084P0800X
CT0420792084P0800X
MA10144482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT537053OtherVALUE OPTIONS
CTP3624013OtherOXFORD
CT001420794Medicaid
CT810698118OtherPHCS
CT15-54607OtherUNITED BEHAVIORAL HEALTH
MA1014448Medicaid
CT1420794Medicaid
CO343759OtherMANAGED HEALTH NETWORK
CTI01590Medicare UPIN
CT810698118OtherPHCS