Healthcare Provider Details

I. General information

NPI: 1063941276
Provider Name (Legal Business Name): MARIAM BARSEGHYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # BB7514
AUGUSTA GA
30912-2206
US

IV. Provider business mailing address

14217 VALERIO ST
VAN NUYS CA
91405-1452
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberRTP-15988
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: