Provider Demographics
NPI:1164425096
Name:KOSHKARIAN, GREGORY MERRILL (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MERRILL
Last Name:KOSHKARIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 N CAMPBELL AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-3540
Mailing Address - Fax:520-325-3526
Practice Address - Street 1:6080 N LA CHOLLA BLVD # 200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3533
Practice Address - Country:US
Practice Address - Phone:520-797-8550
Practice Address - Fax:520-797-6986
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24327207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1033508OtherFIRST HEALTH
AZ10055687OtherPPO NEXT
AZ1Z3634OtherHEALTH NET
AZ351057Medicaid
CAXPY196923Medicaid
AZ102612OtherPREFERRED HEALTH NETWORK
AZ5073466OtherCCN
WA0143348OtherSTATE OF WA DEPT OF LABOR
AZ100666OtherONE HEALTH
AZAZ0860310OtherBCBS OF ARIZONA
AZ060057126OtherRAILROAD MEDICARE
WY1172298 00Medicaid
AZ5132491OtherAETNA
AZ005502491OtherCIGNA
AZ2198525OtherGHI
AZ25-00275OtherUNITED HEALTHCARE
WA8274243OtherSTATE OF WA HLTH & SOC SR
AZAZ0860310OtherBCBS OF ARIZONA
AZ351057Medicaid
AZZ61509Medicare PIN
CAXPY196923Medicaid