Healthcare Provider Details

I. General information

NPI: 1487846804
Provider Name (Legal Business Name): DEMIRJIAN NEUROLOGY & PAIN MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7034 CORPORATE WAY
CENTERVILLE OH
45459-4237
US

IV. Provider business mailing address

3732 BLOSSOM HEATH RD
DAYTON OH
45419-1109
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-3800
  • Fax: 937-296-0272
Mailing address:
  • Phone: 937-298-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35048624D
License Number StateOH

VIII. Authorized Official

Name: DR. CHARLES DEMIRJIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 937-298-3800