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General NPI Number Information
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NPI Number | 1760777635
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Entity Type | Individual
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Provider Name | VATCHE TCHEKMEDYIAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2011
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 265 WESTERN AVE STE 2
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2458
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Country | US
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Telephone | 207-661-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 95 PARK DR APT. #14
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City | BOSTON
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State | MA
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Zip | 02215-5255
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Country | US
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Telephone | 917-628-5324
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | MD22978
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License Number State | ME
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