Healthcare Provider Details

I. General information

NPI: 1639349319
Provider Name (Legal Business Name): HOVIK TAYMOORIAN DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8028 RITCHIE HWY SUITE 126
PASADENA MD
21122-1075
US

IV. Provider business mailing address

8028 RITCHIE HWY SUITE 126
PASADENA MD
21122-1075
US

V. Phone/Fax

Practice location:
  • Phone: 410-768-6702
  • Fax: 410-768-6704
Mailing address:
  • Phone: 410-768-6702
  • Fax: 410-768-6704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberH0054974
License Number StateMD

VIII. Authorized Official

Name: DANIELLE ROSE TAYMOORIAN
Title or Position: MANAGER
Credential:
Phone: 410-768-6702