Provider Demographics
NPI:1053757781
Name:GYULNAZARYAN, VAHE (MD)
Entity type:Individual
Prefix:DR
First Name:VAHE
Middle Name:
Last Name:GYULNAZARYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1529
Mailing Address - Country:US
Mailing Address - Phone:902-882-2664
Mailing Address - Fax:
Practice Address - Street 1:1255 S CEDAR CREST BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6232
Practice Address - Country:US
Practice Address - Phone:610-402-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA154219207R00000X
PAMT204467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty