MEDICARE: DR. ANAMIKA D GHISTA 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
1	207R00000X	Internal Medicine Physician	254151-1	NY

General Provider Information

NPI Number	:	1568798650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANAMIKA D GHISTA M.D.

Provider Business Mailing Address
First Line	:	885 3RD AVE
Second Line	:	C/O LATHAM & WATKINS LLP
City	:	NEW YORK
State	:	NY
Zip	:	10022-4834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	885 3RD AVE
Second Line	:	C/O LATHAM & WATKINS LLP
City	:	NEW YORK
State	:	NY
Zip	:	10022-4834
Country	:	US
Telephone Number	:	212-906-1200
Fax Number	:

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

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	04/29/2010

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