Active NPI
Alexander Mamourian, MD
- Neuroradiology Physician
- Hershey, PA
National Provider Identifier
1619997301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuroradiology Physician
- License
- MD032261E
- Practice address
- 500 University Dr
Hershey, PA 17033 - Phone
- (717) 531-8044
- Fax
- (717) 531-5596
- NPI assigned
- Jul 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuroradiology Physician | 2085N0700X | 8974 | NH | |
| Neuroradiology Physician | 2085N0700X | MD032261E | PA | Primary |
Addresses
Primary practice location
500 University Dr
Hershey, PA 17033
Mailing address
PO Box 858
MC A410
Hershey, PA 17033-0858
Phone (800) 243-1455
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0RE2778 | Medicaid | VT | |
| 101934687 | Medicaid | PA | |
| 99002778 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8974 | NH | MD | Neuroradiology Physician |
| MD032261E | PA | MD | Neuroradiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trustees of the University of Pennsylvania | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Philadelphia, PA
- NPI 1124882949
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536192000000",
"number": "1619997301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 858",
"address_2": "MC A410",
"city": "HERSHEY",
"state": "PA",
"postal_code": "170330858",
"telephone_number": "800-243-1455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 UNIVERSITY DR",
"city": "HERSHEY",
"state": "PA",
"postal_code": "17033",
"telephone_number": "717-531-8044",
"fax_number": "717-531-5596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAMOURIAN",
"first_name": "ALEXANDER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2018-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "NH",
"license": "8974",
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "PA",
"license": "MD032261E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0RE2778",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101934687",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "99002778",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hershey, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.