Healthcare Provider Details

I. General information

NPI: 1366437170
Provider Name (Legal Business Name): MIHRAN A ARTINIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE
BOSTON MA
02120-2847
US

IV. Provider business mailing address

125 PARKER HILL AVE
BOSTON MA
02120-2847
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-6687
  • Fax:
Mailing address:
  • Phone: 617-754-5290
  • Fax: 617-754-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number73273
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number73273
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: