Healthcare Provider Details

I. General information

NPI: 1134130735
Provider Name (Legal Business Name): VARTAN YEGHIAZARIANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 MERRIMACK ST
METHUEN MA
01844-5821
US

IV. Provider business mailing address

411 MERRIMACK ST
METHUEN MA
01844-5821
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-5627
  • Fax: 978-688-3987
Mailing address:
  • Phone: 978-685-5627
  • Fax: 978-688-3987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number150516
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9895
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: