Provider Demographics
NPI:1457525669
Name:MINASYAN, SERGEY L (CERTIFIED FA)
Entity type:Individual
Prefix:MR
First Name:SERGEY
Middle Name:L
Last Name:MINASYAN
Suffix:
Gender:M
Credentials:CERTIFIED FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 YOAKUM PKWY
Mailing Address - Street 2:1016
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3800
Mailing Address - Country:US
Mailing Address - Phone:703-888-0217
Mailing Address - Fax:703-286-7514
Practice Address - Street 1:205 YOAKUM PKWY
Practice Address - Street 2:1016
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3800
Practice Address - Country:US
Practice Address - Phone:703-888-0217
Practice Address - Fax:703-286-7514
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant