Basic Information
| Provider Information | |||||||||
| NPI: | 1245473990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARKISSIAN | ||||||||
| FirstName: | HAGOP | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6048 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977086048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413824900 | ||||||||
| FaxNumber: | 5417062398 | ||||||||
| Practice Location | |||||||||
| Address1: | 2090 NE WYATT CT STE 101 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977017691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413826447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2009 | ||||||||
| LastUpdateDate: | 01/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD190807 | OR | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | 37937 | SC | N | Allopathic & Osteopathic Physicians | Urology | 390200000X | VT | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 500758709 | 05 | OR | MEDICAID |