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General NPI Number Information
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NPI Number | 1003741562
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Entity Type | Individual
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Provider Name | EDEN KIMIAGAROV DO
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Gender | Female
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Dates
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Enumeration Date | 06/16/2026
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Last Update Date | 06/16/2026
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Provider Practice Location Address
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Address Line | 5515 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509-2603
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Country | US
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Telephone | 814-868-8217
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Fax |
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Provider Business Mailing Address
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Address Line | 5310 ROME DR APT 101
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City | ERIE
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State | PA
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Zip | 16509-3869
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Country | US
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Telephone | 954-759-1563
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | OT025465
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License Number State | PA
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