Provider Demographics
NPI:1205299930
Name:MATEVOSYAN, ADELAIDA (MD)
Entity type:Individual
Prefix:DR
First Name:ADELAIDA
Middle Name:
Last Name:MATEVOSYAN
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 1:826 WASHINGTON RD STE 204A
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5780
Mailing Address - Country:US
Mailing Address - Phone:410-525-5144
Mailing Address - Fax:
Practice Address - Street 1:826 WASHINGTON RD STE 204A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5780
Practice Address - Country:US
Practice Address - Phone:410-525-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0091199207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease