Provider Demographics
NPI:1174568463
Name:POOCHIKIAN, VICKEN K (MD)
Entity type:Individual
Prefix:DR
First Name:VICKEN
Middle Name:K
Last Name:POOCHIKIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5632 ANNAPOLIS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2213
Mailing Address - Country:US
Mailing Address - Phone:301-779-7607
Mailing Address - Fax:301-927-0335
Practice Address - Street 1:5632 ANNAPOLIS RD STE 3
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2213
Practice Address - Country:US
Practice Address - Phone:301-779-7607
Practice Address - Fax:301-927-0335
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0034722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1427219997Other1427219997 ENTITY NUMBER 2 LINKED 217153 TO 517588
DC1427219997Other1427219997 ENTITY NUMBER 2 LINKED 217153 TO 517588
DC517588Medicare PIN
DCE63754Medicare UPIN