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NPI Code Detail

MEDICARE: DR. DEVABRATA GANGULY M.D.

MEDICARE: DR. DEVABRATA GANGULY M.D.
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
1207R00000XInternal Medicine PhysicianK7287TX
2207RG0300XGeriatric Medicine (Internal Medicine) PhysicianK7287TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2110247089OTHERTXRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10096JEOTHERTXBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225077274
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEVABRATA GANGULY M.D.
Provider Business Mailing Address
First Line : 3144 CLARKSVILLE ST
Second Line :
City : PARIS
State : TX
Zip : 75460-8002
Country : US
Telephone Number : 903-784-8700
Fax Number : 903-784-7502
Provider Business Practice Location Address
First Line : 1210 W MAIN ST
Second Line :
City : CLARKSVILLE
State : TX
Zip : 75426-3523
Country : US
Telephone Number : 903-427-0500
Fax Number : 903-427-0503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 09/28/2015

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