Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0122X | Plastic and Reconstructive Surgery | 130523 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 255422 | MA |
NPI | 1174647192 |
---|---|
Provider Name | Dr. Mark Khajag Markarian |
First Address | Whittier, CA 90603-2048 |
Second Address | Wellesley, MA 02481-2152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 21/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ASO2532199092 | DEA CERTIFICATE (01) | NV |
LL1592 | MEDICAL LICENSE (01) | NV |