Provider Demographics
NPI:1134246465
Name:AZIZIAN, MARIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:AZIZIAN
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 1:100 TEATICKET HWY
Mailing Address - Street 2:BUILDING #3
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5678
Mailing Address - Country:US
Mailing Address - Phone:508-444-6989
Mailing Address - Fax:508-388-7075
Practice Address - Street 1:100 TEATICKET HWY
Practice Address - Street 2:BUILDING #3
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5678
Practice Address - Country:US
Practice Address - Phone:508-444-6989
Practice Address - Fax:508-388-7075
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13526208600000X
MA251913208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110095392AMedicaid
NH30207098Medicaid
NHP00921047OtherRAILROAD MEDICARE
MA000298103Medicare PIN
MA110095392AMedicaid