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General NPI Number Information
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NPI Number | 1437142239
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Entity Type | Individual
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Provider Name | ALI M GHARAGOZLOO MD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 214 KING ST
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City | OGDENSBURG
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State | NY
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Zip | 13669-1142
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Country | US
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Telephone | 315-393-3600
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Fax | 315-393-9127
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Provider Business Mailing Address
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Address Line | 4567 CROSSROADS PARK DR
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City | LIVERPOOL
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State | NY
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Zip | 13088-3589
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Country | US
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Telephone | 315-434-9307
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Fax | 315-434-9317
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 198556
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License Number State | NY
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