Provider Demographics
NPI:1568203792
Name:MEDALLION TRANSPORTATION INC
Entity type:Organization
Organization Name:MEDALLION TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT (CEO)
Authorized Official - Prefix:
Authorized Official - First Name:GEVORG
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-354-1922
Mailing Address - Street 1:7 E DEXTER AVE UNIT 10
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1667
Mailing Address - Country:US
Mailing Address - Phone:781-354-1922
Mailing Address - Fax:
Practice Address - Street 1:7 E DEXTER AVE UNIT 10
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1667
Practice Address - Country:US
Practice Address - Phone:781-354-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)