Healthcare Provider Details

I. General information

NPI: 1477353472
Provider Name (Legal Business Name): ANGELIKA GEVORGYAN ELECTROLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MAIN ST STE 202
CONCORD MA
01742-3313
US

IV. Provider business mailing address

801 MAIN ST STE 202
CONCORD MA
01742-3313
US

V. Phone/Fax

Practice location:
  • Phone: 617-458-1756
  • Fax:
Mailing address:
  • Phone: 617-458-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number1965
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: