Healthcare Provider Details

I. General information

NPI: 1023332905
Provider Name (Legal Business Name): YERVANT KHATCHERIAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2010
Last Update Date: 01/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29605 US HIGHWAY 19 N SUITE 170
CLEARWATER FL
33761-1537
US

IV. Provider business mailing address

3104 MASTERS DR
CLEARWATER FL
33761-1816
US

V. Phone/Fax

Practice location:
  • Phone: 727-771-8444
  • Fax: 727-771-8604
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME75296
License Number StateFL

VIII. Authorized Official

Name: DR. YERVANT KHATCHERIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 727-771-8444