Individual
HARRY DERDERIAN
Active
Individual
HARRY DERDERIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
22684
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GRP
KY
01
—
4000501
MEDICARE LAB GRP
KY
05
—
64226848
—
KY
01
—
CB5773
RR MEDCARE GRP
GA
Enumeration date
07/04/2006
Last updated
11/02/2007
Update your record
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