Provider Demographics
NPI:1972553543
Name:TAKVORIAN, CAROL R (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:R
Last Name:TAKVORIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 OLD MIDDLESEX RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3457
Mailing Address - Country:US
Mailing Address - Phone:413-329-4658
Mailing Address - Fax:
Practice Address - Street 1:700 ATTUCKS LN
Practice Address - Street 2:THE CAPE AND ISLANDS ENDO CENTER
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1811
Practice Address - Country:US
Practice Address - Phone:508-775-7751
Practice Address - Fax:508-775-7752
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist