Provider Demographics
NPI:1669685111
Name:SIMONYANTS, LUSINE (MD)
Entity Type:Individual
Prefix:
First Name:LUSINE
Middle Name:
Last Name:SIMONYANTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 W GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1912
Mailing Address - Country:US
Mailing Address - Phone:818-637-2200
Mailing Address - Fax:818-637-2250
Practice Address - Street 1:1511 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1912
Practice Address - Country:US
Practice Address - Phone:818-637-2200
Practice Address - Fax:818-637-2250
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104434207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA250018OtherUNISON-WMG
PA50080323OtherCAPITAL BLUS CROSS-WMG
MD940467-01OtherCAREFIRST MD BCBS
PA20080321OtherAMERIHEALTH MERCY-WMG
PA2066650OtherHIGHMARK BLUE SHIELD
PA9164247OtherAETNA
PA001264101Medicaid
PA212462OtherJOHNS HOPKINS
PA121885OtherGEISINGER HEALTH PLAN
PA1577543OtherGATEWAY-WMG
PA001264101Medicaid