Healthcare Provider Details

I. General information

NPI: 1790849883
Provider Name (Legal Business Name): BESSY M MARTIROSYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 S CEDAR ST
GLENDALE CA
91205-1207
US

IV. Provider business mailing address

26 BRYON RD APT. #1
CHESTNUT HILL MA
02467-3333
US

V. Phone/Fax

Practice location:
  • Phone: 818-839-4010
  • Fax:
Mailing address:
  • Phone: 617-789-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number226796
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: