Healthcare Provider Details

I. General information

NPI: 1124026372
Provider Name (Legal Business Name): BEDROS BAKIRTZIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 ANDREWS ST
MASSENA NY
13662-3401
US

IV. Provider business mailing address

271 ANDREWS ST
MASSENA NY
13662-3401
US

V. Phone/Fax

Practice location:
  • Phone: 315-769-9908
  • Fax: 315-764-5430
Mailing address:
  • Phone: 315-769-9908
  • Fax: 315-764-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number178450-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: