Provider Demographics
NPI:1699773978
Name:OHANESIAN, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:OHANESIAN
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 1:919 12TH PL
Mailing Address - Street 2:STE 1
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1433
Mailing Address - Country:US
Mailing Address - Phone:928-778-4300
Mailing Address - Fax:928-771-0920
Practice Address - Street 1:9305 W THOMAS RD STE 155
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3360
Practice Address - Country:US
Practice Address - Phone:623-936-1780
Practice Address - Fax:480-895-9494
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28766207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0875870OtherBLUE CROSS
AZ535726Medicaid
0700586OtherUNITED HEALTHCARE
AZ0875870OtherBLUE CROSS
0700586OtherUNITED HEALTHCARE