Individual
HARRY DERDERIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 N EAGLE CREEK DR, LEXINGTON, KY 40509-1805
(859) 258-5225
(859) 258-5239
Mailing address
100 N EAGLE CREEK DR, LEXINGTON, KY 40509-1805
(859) 258-5225
(859) 258-5239
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
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