Healthcare Provider Details

I. General information

NPI: 1417052366
Provider Name (Legal Business Name): ANTON A. MINASSIAN PAIN MEDICINE & REHABILITATION SVCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7984 OLD GEORGETOWN RD SUITE 7C
BETHESDA MD
20814-2448
US

IV. Provider business mailing address

7984 OLD GEORGETOWN RD SUITE 7C
BETHESDA MD
20814-2448
US

V. Phone/Fax

Practice location:
  • Phone: 301-654-4948
  • Fax: 301-654-0770
Mailing address:
  • Phone: 301-654-4948
  • Fax: 301-654-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0051046
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD0051046
License Number StateMD

VIII. Authorized Official

Name: ANTON ANTRANIK MINASSIAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 301-654-4948