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General NPI Number Information
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NPI Number | 1376585091
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Entity Type | Individual
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Provider Name | SIMON AWADIS OVANESSIAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 300 FRIBERG PKWY
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City | WESTBOROUGH
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State | MA
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Zip | 01581-3900
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Country | US
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Telephone | 508-329-6300
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Fax | 508-329-6088
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Provider Business Mailing Address
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Address Line | 300 FRIBERG PKWY
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City | WESTBOROUGH
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State | MA
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Zip | 01581-3900
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Country | US
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Telephone | 508-329-6300
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Fax | 508-329-6088
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 232261
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 042079
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 1014448
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License Number State | MA
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