Provider Demographics
NPI:1699893099
Name:KETCHEDJIAN, ARMEN G (MD)
Entity type:Individual
Prefix:DR
First Name:ARMEN
Middle Name:G
Last Name:KETCHEDJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-0547
Mailing Address - Country:US
Mailing Address - Phone:203-243-7686
Mailing Address - Fax:203-264-1456
Practice Address - Street 1:929 BOSTON POST RD
Practice Address - Street 2:SUITE 1
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2143
Practice Address - Country:US
Practice Address - Phone:203-243-7686
Practice Address - Fax:203-264-1456
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT035600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V5180OtherACS HEALTHNET
CT500HBA454CT01OtherANTHEM BC BS
CTP2753812OtherOXFORD
CTG16071Medicare UPIN
CT050001352Medicare ID - Type Unspecified