MEDICARE: DR. LANA TELMAN VARDANIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A74071	CA
2	207R00000X	Internal Medicine Physician	273440	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306829064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANA TELMAN VARDANIAN M.D.

Provider Business Mailing Address
First Line	:	2601 OCEAN PKWY
Second Line	:	4N1
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7745
Country	:	US
Telephone Number	:	718-616-3880
Fax Number	:	718-616-4446

Provider Business Practice Location Address
First Line	:	2601 OCEAN PKWY
Second Line	:	406
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7745
Country	:	US
Telephone Number	:	718-616-4415
Fax Number	:	718-616-4633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2005
Last Update Date	:	07/18/2015

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