Physician Compare National (NPI:1417910555)

HEALTHCARE PROVIDER: HERMAN AYVAZYAN MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1417910555
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9133290851
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080624000058
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	AYVAZYAN
	Individual professional last name
Provider First Name	HERMAN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WARREN ALPERT MEDICAL SCHOOL OF BROWN UNIVERSITY
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	450 VETERANS MEMORIAL PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 12
	Group Practice or individual's line 2 address
City	EAST PROVIDENCE
	Group Practice or individual's city
State	RI
	Group Practice or individual's state
Zip Code	029145300
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4014346464
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	410012
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	THE MIRIAM HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	410007
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	RHODE ISLAND HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y