Provider Demographics
NPI:1730249517
Name:DEIRMENGIAN, GREGORY KRIKOR (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:KRIKOR
Last Name:DEIRMENGIAN
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 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:800-321-9999
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:234 MALL BLVD STE G30
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2921
Practice Address - Country:US
Practice Address - Phone:267-339-3558
Practice Address - Fax:267-339-3763
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152545207X00000X
NJ25MA08795400207X00000X
PAMD430661207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery