Provider Demographics
NPI:1063790061
Name:TACHJIAN, ARA LEON (MD)
Entity type:Individual
Prefix:
First Name:ARA
Middle Name:LEON
Last Name:TACHJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:AMBULATORY SERVICES PAVILLION
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-681-4996
Mailing Address - Fax:401-921-6569
Practice Address - Street 1:455 TOLL GATE RD
Practice Address - Street 2:AMBULATORY SERVICES PAVILLION
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2759
Practice Address - Country:US
Practice Address - Phone:401-681-4996
Practice Address - Fax:401-921-6569
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248187207RC0000X
MA261135207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease