MEDICARE: SOUMOJIT GHOSH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	04-50045	KS
2	207RG0100X	Gastroenterology Physician	2021017854	MO

General Provider Information

NPI Number	:	1003310822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOUMOJIT GHOSH MD

Provider Business Mailing Address
First Line	:	11525 OLDE CABIN RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7146
Country	:	US
Telephone Number	:	314-997-0554
Fax Number	:	314-997-5086

Provider Business Practice Location Address
First Line	:	11525 OLDE CABIN RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7146
Country	:	US
Telephone Number	:	314-997-0554
Fax Number	:	314-997-5086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	04/23/2026

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