Basic Information
| Provider Information | |||||||||
| NPI: | 1427056720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TENEKJIAN | ||||||||
| FirstName: | VASKEN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3640 HIGH ST | ||||||||
| Address2: | SUITE 2F | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237073213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573972383 | ||||||||
| FaxNumber: | 7579375201 | ||||||||
| Practice Location | |||||||||
| Address1: | 3640 HIGH ST | ||||||||
| Address2: | SUITE 2F | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237073213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573972383 | ||||||||
| FaxNumber: | 7579375201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 208G00000X | 0101031040 | VA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 25082 | 01 | VA | OPTIMA | OTHER | 890550K | 01 | VA | MEDICAID OF NORTH CAROLIN | OTHER | 325219 | 01 | VA | ANTHEM | OTHER |