Healthcare Provider Details

I. General information

NPI: 1548480916
Provider Name (Legal Business Name): ZAVEN JABOURIAN,M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6139 GOVERNOR GEORGE C.PEERY HIGHWAY
DORAN VA
24612
US

IV. Provider business mailing address

P.O.BOX 656
DORAN VA
24612
US

V. Phone/Fax

Practice location:
  • Phone: 276-964-7439
  • Fax:
Mailing address:
  • Phone: 276-964-7439
  • Fax: 276-963-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101044007
License Number StateVA

VIII. Authorized Official

Name: DR. ZAVEN JABOURIAN
Title or Position: PRESIDENT
Credential:
Phone: 276-964-7439