Basic Information
Provider Information
NPI: 1881114700
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAKARYAN
FirstName: HAYKANUSH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 132 S 10TH ST FL 10
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191075244
CountryCode: US
TelephoneNumber: 2159556000
FaxNumber:  
Practice Location
Address1: 132 S 10TH ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191075244
CountryCode: US
TelephoneNumber: 2159556000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/21/2017
LastUpdateDate: 08/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085N0700XMT213551PAN Allopathic & Osteopathic PhysiciansRadiologyNeuroradiology
2085R0202XMT213551PAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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