Provider Demographics
NPI:1144324716
Name:GEDACHIAN, ROBERT K (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:GEDACHIAN
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 1:100 MLK JR BLVD
Mailing Address - Street 2:2ND FL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1220
Mailing Address - Country:US
Mailing Address - Phone:508-757-1589
Mailing Address - Fax:508-757-5633
Practice Address - Street 1:100 MLK JR BLVD
Practice Address - Street 2:2ND FL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1220
Practice Address - Country:US
Practice Address - Phone:508-757-1589
Practice Address - Fax:508-757-5633
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH11592174400000X
MA31591207KA0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No174400000XOther Service ProvidersSpecialist
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0197203Medicaid
MA0197203Medicaid
NHA67106Medicare UPIN