Provider Demographics
NPI:1619239142
Name:MARTIROSYAN, NIKOLAY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:NIKOLAY
Middle Name:
Last Name:MARTIROSYAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19636 N 27TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4022
Mailing Address - Country:US
Mailing Address - Phone:623-562-5050
Mailing Address - Fax:623-562-5051
Practice Address - Street 1:19636 N 27TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4022
Practice Address - Country:US
Practice Address - Phone:623-562-5050
Practice Address - Fax:623-562-5051
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR73272207T00000X
IAMD-45705207T00000X
AZ51146207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery