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NPI Code Detail

MEDICARE: ALI M GHARAGOZLOO MD

MEDICARE: ALI M GHARAGOZLOO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician198556NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437142239
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALI M GHARAGOZLOO MD
Provider Business Mailing Address
First Line : 4567 CROSSROADS PARK DR
Second Line :
City : LIVERPOOL
State : NY
Zip : 13088-3589
Country : US
Telephone Number : 315-434-9307
Fax Number : 315-434-9317
Provider Business Practice Location Address
First Line : 214 KING ST
Second Line :
City : OGDENSBURG
State : NY
Zip : 13669-1142
Country : US
Telephone Number : 315-393-3600
Fax Number : 315-393-9127
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2005
Last Update Date : 09/12/2007

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