Individual
MATIG MAVISSAKALIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-2400
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
35-054348
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224304
UNISON
OH
01
—
000000532980
ANTHEM
OH
05
—
0657954
—
OH
01
—
260034031
RAILROAD MEDICARE
OH
01
—
363816
WELLCARE MEDICAID
OH
01
—
4350470
AETNA
OH
Enumeration date
07/15/2006
Last updated
01/15/2021
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