Provider Demographics
NPI:1023775756
Name:AIRAPETIAN, SUREN
Entity type:Individual
Prefix:
First Name:SUREN
Middle Name:
Last Name:AIRAPETIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S KESWICK PLZ UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1675
Mailing Address - Country:US
Mailing Address - Phone:215-834-2865
Mailing Address - Fax:267-364-5502
Practice Address - Street 1:3300 S KESWICK PLZ UNIT 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1675
Practice Address - Country:US
Practice Address - Phone:215-834-2865
Practice Address - Fax:267-364-5502
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA61783601374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide