Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD054636L | PA |
N | 207XS0106X | Orthopaedic Hand Surgeon | 206625 | NY |
N | 207XS0106X | Orthopaedic Hand Surgeon | 25MA06879000 | NJ |
N | 207XS0106X | Orthopaedic Hand Surgeon | C1-0005533 | DE |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD054363L | PA |
NPI | 1114955689 |
---|---|
Provider Name | Pedro Kirkor Beredjiklian |
First Address | Philadelphia, PA 19107-4430 |
Second Address | Philadelphia, PA 19107-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001699860 | (05) | PA |
G72125 | (02) |