MEDICARE: GREGORY MERRILL KOSHKARIAN 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
1	207RC0000X	Cardiovascular Disease Physician	24327	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	060057126	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1033508	OTHER	AZ	FIRST HEALTH
2	10055687	OTHER	AZ	PPO NEXT
3	1Z3634	OTHER	AZ	HEALTH NET
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	102612	OTHER	AZ	PREFERRED HEALTH NETWORK
7	5073466	OTHER	AZ	CCN
8	0143348	OTHER	WA	STATE OF WA DEPT OF LABOR
9	100666	OTHER	AZ	ONE HEALTH
10	AZ0860310	OTHER	AZ	BCBS OF ARIZONA
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	5132491	OTHER	AZ	AETNA
14	005502491	OTHER	AZ	CIGNA
15	2198525	OTHER	AZ	GHI
16	25-00275	OTHER	AZ	UNITED HEALTHCARE
17	8274243	OTHER	WA	STATE OF WA HLTH & SOC SR

General Provider Information

NPI Number	:	1164425096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY MERRILL KOSHKARIAN MD

Provider Business Mailing Address
First Line	:	3709 N CAMPBELL AVE
Second Line	:	STE 201
City	:	TUCSON
State	:	AZ
Zip	:	85719-1563
Country	:	US
Telephone Number	:	520-838-3540
Fax Number	:	520-325-3526

Provider Business Practice Location Address
First Line	:	6080 N LA CHOLLA BLVD # 200
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3533
Country	:	US
Telephone Number	:	520-797-8550
Fax Number	:	520-797-6986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/29/2020

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