Provider Demographics
NPI:1306829064
Name:VARDANIAN, LANA TELMAN (MD)
Entity type:Individual
Prefix:DR
First Name:LANA
Middle Name:TELMAN
Last Name:VARDANIAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2601 OCEAN PKWY
Mailing Address - Street 2:4N1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7745
Mailing Address - Country:US
Mailing Address - Phone:718-616-3880
Mailing Address - Fax:718-616-4446
Practice Address - Street 1:2601 OCEAN PKWY
Practice Address - Street 2:406
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7745
Practice Address - Country:US
Practice Address - Phone:718-616-4415
Practice Address - Fax:718-616-4633
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2015-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA74071207R00000X
NY273440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A740710Medicaid
CA00A740710Medicaid