Basic Information
| Provider Information | |||||||||
| NPI: | 1164839700 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GEVORGYAN | ||||||||
| FirstName: | OFELYA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 W HARRISON ST STE 466 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123800 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 315 MARTIN LUTHER KING JR WAY | ||||||||
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| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534031000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2014 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | MD60954239 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 390200000X | 036.141330 | IL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.