Healthcare Provider Details

I. General information

NPI: 1427056720
Provider Name (Legal Business Name): VASKEN K TENEKJIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 HIGH ST SUITE 2F
PORTSMOUTH VA
23707-3213
US

IV. Provider business mailing address

3640 HIGH ST SUITE 2F
PORTSMOUTH VA
23707-3213
US

V. Phone/Fax

Practice location:
  • Phone: 757-397-2383
  • Fax: 757-937-5201
Mailing address:
  • Phone: 757-397-2383
  • Fax: 757-937-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101031040
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: