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General NPI Number Information
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NPI Number | 1619134921
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Entity Type | Organization
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Legal Business Name | HERMAN AYVAZYAN
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 450 VETERANS MEMORIAL PKWY # 12
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-5300
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Country | US
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Telephone | 401-434-6464
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Fax | 401-438-1890
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Provider Business Mailing Address
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Address Line | 450 VETERANS MEMORIAL PKWY # 12
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-5300
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Country | US
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Telephone | 401-434-6464
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Fax | 401-438-1890
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. HERMAN AYVAZYAN
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Credential | MD
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Telephone | 401-434-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 7061
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License Number State | RI
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