Provider Demographics
NPI:1760484596
Name:SENEKJIAN, HARRY O (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:O
Last Name:SENEKJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BLVD
Mailing Address - Street 2:SUITE 2635
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3244
Mailing Address - Country:US
Mailing Address - Phone:801-387-6820
Mailing Address - Fax:801-387-6825
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:SUITE 2635
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3244
Practice Address - Country:US
Practice Address - Phone:801-387-6820
Practice Address - Fax:801-387-6825
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT169315 1205174400000X
UT169315207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT31896OtherGEM STATE
UT8445OtherDMBA
UT000060400OtherIDAHO MEDICAID
UT68391OtherPEHP
UT07331Medicaid
UT1760484596Medicaid
UT0400649OtherUHC
UT1167014 00OtherACS
UTQM0000056196OtherALTIUS
UT107004821101OtherIHC
UT107004821101OtherHIP
UT110234858OtherPALMETTO RR INS
UTPR00533OtherMOLINA
UT1760484596Medicaid
UT0400649OtherUHC
UTPR00533OtherMOLINA