Provider Demographics
NPI:1801908280
Name:SEVADJIAN, CHARLES MARSHAL (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARSHAL
Last Name:SEVADJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2881 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6207
Mailing Address - Country:US
Mailing Address - Phone:619-291-8292
Mailing Address - Fax:619-291-8229
Practice Address - Street 1:2881 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6207
Practice Address - Country:US
Practice Address - Phone:619-291-8292
Practice Address - Fax:619-291-8229
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38526207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A36492Medicare UPIN
CAC38526Medicare ID - Type Unspecified