Provider Demographics
NPI:1508108986
Name:GHARAGOZLOU, BARSAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BARSAM
Middle Name:
Last Name:GHARAGOZLOU
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 1:2260 GLADSTONE DR STE 8
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5125
Mailing Address - Country:US
Mailing Address - Phone:925-267-6000
Mailing Address - Fax:925-267-6100
Practice Address - Street 1:2260 GLADSTONE DR STE 8
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5125
Practice Address - Country:US
Practice Address - Phone:925-303-4500
Practice Address - Fax:925-517-6500
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-23
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143860208M00000X
CA1123971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA143860OtherSTATE MEDICAL LICENSE