Basic Information
| Provider Information | |||||||||
| NPI: | 1457883258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NADJARIAN | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 ALBANY ST FL GROUND | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021192560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174145405 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 MASSACHUSETTS AVE | ||||||||
| Address2: | CROSSTOWN 2 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174147399 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2017 | ||||||||
| LastUpdateDate: | 03/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 282009 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110127216A | 05 | MA | MEDICAID |