Provider Demographics
NPI:1548732456
Name:LIYA GALOOSHIAN MD PC
Entity type:Organization
Organization Name:LIYA GALOOSHIAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALOOSHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-467-9144
Mailing Address - Street 1:425 N 21ST ST STE 406
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2223
Mailing Address - Country:US
Mailing Address - Phone:301-467-9144
Mailing Address - Fax:
Practice Address - Street 1:425 N 21ST ST STE 406
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2223
Practice Address - Country:US
Practice Address - Phone:301-467-9144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care