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NPI Code Detail

MEDICARE: PRODYOT GHOSH M.D.

MEDICARE: PRODYOT GHOSH 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
1207RG0100XGastroenterology Physician01043532AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780689257
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRODYOT GHOSH M.D.
Provider Business Mailing Address
First Line : 550 S LANDMARK AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3239
Country : US
Telephone Number : 812-333-5973
Fax Number : 812-330-3681
Provider Business Practice Location Address
First Line : 550 S LANDMARK AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3239
Country : US
Telephone Number : 812-333-5973
Fax Number : 812-330-3681
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 12/12/2025

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