Provider Demographics
NPI:1265753487
Name:GALUSHA, ANDREW DAVID (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:GALUSHA
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 1:3691 PARK OVERLOOK DR
Mailing Address - Street 2:APT 207
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-7404
Mailing Address - Country:US
Mailing Address - Phone:937-286-1397
Mailing Address - Fax:
Practice Address - Street 1:3535 PENTAGON BLVD STE 320
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1705
Practice Address - Country:US
Practice Address - Phone:937-702-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH126044208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0122787Medicaid
OHH388270Medicare PIN