Provider Demographics
NPI:1427102862
Name:AGHAYAN, ARIC SAMAD (MD)
Entity type:Individual
Prefix:
First Name:ARIC
Middle Name:SAMAD
Last Name:AGHAYAN
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 1:140 NW 14TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2601
Mailing Address - Country:US
Mailing Address - Phone:503-212-9411
Mailing Address - Fax:
Practice Address - Street 1:MARINE CORPS BASE HAWAII
Practice Address - Street 2:1ST BATTALION, 12TH MARINES
Practice Address - City:KANEOHE BAY
Practice Address - State:HI
Practice Address - Zip Code:96863
Practice Address - Country:US
Practice Address - Phone:808-257-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD171065208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty