Provider Demographics
NPI:1932395928
Name:HAGOP L DERKRIKORIAN, MD, PC
Entity Type:Organization
Organization Name:HAGOP L DERKRIKORIAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAGOP
Authorized Official - Middle Name:LEVON
Authorized Official - Last Name:DERKRIKORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-566-7787
Mailing Address - Street 1:1098 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 3306
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5139
Mailing Address - Country:US
Mailing Address - Phone:610-566-7787
Mailing Address - Fax:610-892-9127
Practice Address - Street 1:1098 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 3306
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5139
Practice Address - Country:US
Practice Address - Phone:610-566-7787
Practice Address - Fax:610-892-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0030876000OtherIBC
DE2146620000OtherIBC
PA426576Medicare PIN
DE00B381H08Medicare PIN
PA0030876000OtherIBC
DEG01008Medicare PIN