Provider Demographics
NPI:1225081706
Name:GALVAO, LUIZ FELIPE (MD)
Entity type:Individual
Prefix:
First Name:LUIZ
Middle Name:FELIPE
Last Name:GALVAO
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:PO BOX 31
Mailing Address - Street 2:959 WYOMING AVE
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501-0031
Mailing Address - Country:US
Mailing Address - Phone:570-344-3517
Mailing Address - Fax:570-344-6839
Practice Address - Street 1:959 WYOMING AVE
Practice Address - Street 2:SCRANTON PRIMARY HEALTH CARE CENTER
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-3023
Practice Address - Country:US
Practice Address - Phone:570-344-9684
Practice Address - Fax:570-969-0968
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062166L207R00000X
PAMD062166-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001652757Medicaid
PA000000082714OtherMEDPLUS
PA959155OtherHIGHMARK
PA959155Medicare ID - Type Unspecified
PA959155F5FMedicare PIN
PA001652757Medicaid
G55561Medicare UPIN