Provider Demographics
NPI:1831580661
Name:MEGERDICHIAN, ANI ZABELLE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ANI
Middle Name:ZABELLE
Last Name:MEGERDICHIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CROCUS DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5801
Mailing Address - Country:US
Mailing Address - Phone:401-261-9174
Mailing Address - Fax:
Practice Address - Street 1:41 CROCUS DR
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5801
Practice Address - Country:US
Practice Address - Phone:401-261-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00786363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical