Basic Information
Provider Information | |||||||||
NPI: | 1578661955 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | VARUJAN AREK KELEDJIAN, MD, INC A PROFESSIONAL CORPORATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3903 LONE TREE WAY STE 205 | ||||||||
Address2: |   | ||||||||
City: | ANTIOCH | ||||||||
State: | CA | ||||||||
PostalCode: | 945096269 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9257548710 | ||||||||
FaxNumber: | 9257540765 | ||||||||
Practice Location | |||||||||
Address1: | 3903 LONE TREE WAY STE 205 | ||||||||
Address2: |   | ||||||||
City: | ANTIOCH | ||||||||
State: | CA | ||||||||
PostalCode: | 945096269 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9257548710 | ||||||||
FaxNumber: | 9257540765 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/20/2006 | ||||||||
LastUpdateDate: | 09/02/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KELEDJIAN | ||||||||
AuthorizedOfficialFirstName: | VARUJAN | ||||||||
AuthorizedOfficialMiddleName: | AREK | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 9257548710 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | A46647 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.