Provider Demographics
NPI:1396949830
Name:MATEVOSYAN, KAREN (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MATEVOSYAN
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:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284
Mailing Address - Country:US
Mailing Address - Phone:214-648-9182
Mailing Address - Fax:214-648-8037
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:CHARLES SPRAGUE BUILDING, CS3.114
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9073
Practice Address - Country:US
Practice Address - Phone:214-648-9182
Practice Address - Fax:214-648-8037
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8319207ZB0001X, 207ZC0006X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP2-0026709OtherINSTITUTIONAL PERMIT