Provider Demographics
NPI:1912141979
Name:DER MESROPIAN, PAUL JACK (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JACK
Last Name:DER MESROPIAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:113 HOLLAND AVE
Mailing Address - Street 2:ALBANY STRATTON VA - DIVISION OF NEPHROLOGY
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3410
Mailing Address - Country:US
Mailing Address - Phone:518-626-5000
Mailing Address - Fax:
Practice Address - Street 1:113 HOLLAND AVE
Practice Address - Street 2:ALBANY STRATTON VA - DIVISION OF NEPHROLOGY
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3410
Practice Address - Country:US
Practice Address - Phone:518-626-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY270579207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology