Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 01040196 | IN |
NPI | 1013968700 |
---|---|
Provider Name | Vatche A Israbian |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-0025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000576545 | ANTHEM (01) | IN |
000000670347 | ANTHEM (01) | IN |
200148740 | (05) | IN |
G60382 | (02) | IN |
P00790184 | R.R. MEDICARE (01) | IN |