Basic Information
| Provider Information | |||||||||
| NPI: | 1366476731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARSEGHIAN | ||||||||
| FirstName: | SHANT | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 92 MONTVALE AVE | ||||||||
| Address2: | SUITE 3675 | ||||||||
| City: | STONEHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814381800 | ||||||||
| FaxNumber: | 7814381822 | ||||||||
| Practice Location | |||||||||
| Address1: | 92MONTVALE AVE | ||||||||
| Address2: | SUITE 3675 | ||||||||
| City: | STONEHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814381800 | ||||||||
| FaxNumber: | 7814381822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 03/28/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 239269 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | P00358375 | 01 | RAILROAD MEDICARE | OTHER | 250766 | 01 | HEALTH LINK | OTHER | 308311308 | 05 | MO | MEDICAID | I62086 | 01 | PREMIER PLUS | OTHER | 215199 | 01 | BCBS | OTHER |